Provider Demographics
NPI:1730581281
Name:BUTLER, ADELIA
Entity type:Individual
Prefix:
First Name:ADELIA
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 MAINE AVE STE 750
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-2133
Mailing Address - Country:US
Mailing Address - Phone:510-804-0728
Mailing Address - Fax:510-374-6294
Practice Address - Street 1:23 MAINE AVE STE 750
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-2133
Practice Address - Country:US
Practice Address - Phone:510-804-0728
Practice Address - Fax:510-374-6294
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47-1424025347C00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle