Healthcare Provider Details

I. General information

NPI: 1104925205
Provider Name (Legal Business Name): MICHAEL LAWRENCE BUTERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6699 ALVARADO RD STE 2309
SAN DIEGO CA
92120-5241
US

IV. Provider business mailing address

PO BOX 1009
SPRING VALLEY CA
91979-1009
US

V. Phone/Fax

Practice location:
  • Phone: 619-286-8803
  • Fax: 619-286-2344
Mailing address:
  • Phone: 619-508-0908
  • Fax: 619-693-3242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberG70238
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: