Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | A110453 | CA |
Y | 2080P0201X | Pediatric Allergist | A110453 | CA |
NPI | 1801861216 |
---|---|
Provider Name | Dr. Manish Janardhan Butte |
First Address | Los Angeles, CA 90095-1556 |
Second Address | Los Angeles, CA 90095-2200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2006 |
Last Update Date | 31/05/2017 |