Healthcare Provider Details

I. General information

NPI: 1013331990
Provider Name (Legal Business Name): MR. DANA DELAINE BUTLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 LIVINGSTON AVE # CA92870
PLACENTIA CA
92870-2546
US

IV. Provider business mailing address

14700 MANZANITA PARK ROAD
BEAUMONT CA
92223
US

V. Phone/Fax

Practice location:
  • Phone: 714-617-4886
  • Fax:
Mailing address:
  • Phone: 951-845-3155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number124730
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: