MEDICARE: JERRY BUTANDA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	240297026	CA

General Provider Information

NPI Number	:	1013865310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRY BUTANDA

Provider Business Mailing Address
First Line	:	1519 E OAK HILL CT
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91761-6330
Country	:	US
Telephone Number	:	909-820-7700
Fax Number	:

Provider Business Practice Location Address
First Line	:	182 E WALNUT AVE
Second Line	:
City	:	RIALTO
State	:	CA
Zip	:	92376-3598
Country	:	US
Telephone Number	:	909-820-7700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2026
Last Update Date	:	03/20/2026

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Directions to “ JERRY BUTANDA ” Practice Location

Language	Start Address	Practice Location

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