Provider Demographics
NPI:1033732862
Name:GROBAREK-BUTLER, BRITNEY MOONCHILD (LAC, DACM)
Entity Type:Individual
Prefix:
First Name:BRITNEY
Middle Name:MOONCHILD
Last Name:GROBAREK-BUTLER
Suffix:
Gender:F
Credentials:LAC, DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6728 THOMSON CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-5935
Mailing Address - Country:US
Mailing Address - Phone:619-249-5105
Mailing Address - Fax:
Practice Address - Street 1:2405 MORENA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4139
Practice Address - Country:US
Practice Address - Phone:619-777-3294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18866171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist