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NPI Code Detail

MEDICARE: LAURA BUTNER PA

MEDICARE:   LAURA  BUTNER  PA
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
1363A00000XPhysician AssistantPA 9108122FL
2363A00000XPhysician AssistantPA57852CA

General Provider Information

NPI Number : 1457752842
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA BUTNER PA
Provider Business Mailing Address
First Line : 210 N TUSTIN AVE
Second Line :
City : SANTA ANA
State : CA
Zip : 92705-3807
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1840 WEST DR
Second Line :
City : VISTA
State : CA
Zip : 92083-6115
Country : US
Telephone Number : 240-321-3700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2014
Last Update Date : 06/13/2025

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Directions to “ LAURA BUTNER PA” Practice Location

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