Provider Demographics
NPI:1073033387
Name:BUTTE, JILL MARIE MADISON (RD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE MADISON
Last Name:BUTTE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:MADISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:4650 W SUNSET BLVD # 8
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6062
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4650 SUNSET BLVD
Practice Address - Street 2:MAIL STOP 8
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027
Practice Address - Country:US
Practice Address - Phone:323-361-4173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1091637133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric