Provider Demographics
NPI:1447995105
Name:BUTLER, JUDY (CNC)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:CNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 HYDE CT
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-6915
Mailing Address - Country:US
Mailing Address - Phone:171-426-7655
Mailing Address - Fax:
Practice Address - Street 1:914 HYDE CT
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-6915
Practice Address - Country:US
Practice Address - Phone:171-426-7655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist