Healthcare Provider Details

I. General information

NPI: 1225366305
Provider Name (Legal Business Name): EVANGELINE G ROXAS-BUTLIG MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2009
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1727 CRENSHAW BLVD
TORRANCE CA
90501
US

IV. Provider business mailing address

1727 CRENSHAW BLVD
TORRANCE CA
90501
US

V. Phone/Fax

Practice location:
  • Phone: 310-373-7855
  • Fax: 424-704-2493
Mailing address:
  • Phone: 310-373-7855
  • Fax: 424-704-2493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA78060
License Number StateCA

VIII. Authorized Official

Name: DR. EVANGELINE GIDAYA ROXAS-BUTLIG
Title or Position: PRESIDENT
Credential: MD
Phone: 310-373-7855