Healthcare Provider Details

I. General information

NPI: 1235968231
Provider Name (Legal Business Name): BUTTERFLY HAUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/29/2024
Certification Date: 07/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1754 TECHNOLOGY DR
SAN JOSE CA
95110-1308
US

IV. Provider business mailing address

1754 TECHNOLOGY DR
SAN JOSE CA
95110-1308
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: J C
Title or Position: AGENT
Credential:
Phone: --