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NPI Code Detail

MEDICARE: RENEE ELIZABETH BOUTIN R1616260525

MEDICARE: RENEE ELIZABETH BOUTIN R1616260525
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
1101YA0400XAddiction (Substance Use Disorder) CounselorR1616260525CA

General Provider Information

NPI Number : 1215889811
Entity Type Code : Individual
Provider Name (Legal Business Name) : RENEE ELIZABETH BOUTIN R1616260525
Provider Business Mailing Address
First Line : 12781 JOSEPHINE ST
Second Line :
City : GARDEN GROVE
State : CA
Zip : 92841-4622
Country : US
Telephone Number : 657-251-0503
Fax Number :
Provider Business Practice Location Address
First Line : 12781 JOSEPHINE ST
Second Line :
City : GARDEN GROVE
State : CA
Zip : 92841-4622
Country : US
Telephone Number : 657-251-0503
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2026
Last Update Date : 02/14/2026

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Directions to “ RENEE ELIZABETH BOUTIN R1616260525” Practice Location

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