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General NPI Number Information
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NPI Number | 1235149170
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Entity Type | Organization
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Legal Business Name | SOUTHERN CALIFORNIA HEAD & NECK MEDICAL GROUP
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 03/07/2016
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Provider Practice Location Address
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Address Line | 1301 20TH ST STE 300
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City | SANTA MONICA
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State | CA
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Zip | 90404-2087
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Country | US
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Telephone | 310-829-7792
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Fax | 310-829-4136
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Provider Business Mailing Address
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Address Line | 1301 20TH ST STE 300
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City | SANTA MONICA
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State | CA
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Zip | 90404-2087
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Country | US
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Telephone | 310-829-7792
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Fax | 310-829-4136
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Authorized Official
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Title or Position | PARTNER
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Name | DAVID MICHAEL BUTLER
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Credential | M.D.
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Telephone | 310-829-7792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G26964
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License Number State | CA
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