1356628879 NPI number — MRS. TAMARA NICOLE WILLIAMS-BUTLER LMT, L.AC.

Table of content: MRS. TAMARA NICOLE WILLIAMS-BUTLER LMT, L.AC. (NPI 1356628879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356628879 NPI number — MRS. TAMARA NICOLE WILLIAMS-BUTLER LMT, L.AC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS-BUTLER
Provider First Name:
TAMARA
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMT, L.AC.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356628879
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1907 ROBINSON AVE
Provider Second Line Business Mailing Address:
UNIT 307
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92104-8200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-324-9887
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
540 3RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92101-6805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-324-9887
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/11/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  10386 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171100000X , with the licence number: AC 15795 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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