Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | SL5167 | CA |
NPI | 1013395516 |
---|---|
Provider Name | Ms. Angela Kristine Butler |
First Address | Yuba City, CA 95991-4434 |
Second Address | Yuba City, CA 95991-4434 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2015 |
Last Update Date | 15/05/2015 |