Provider Demographics
NPI:1003877531
Name:ROXAS-BUTLIG, EVANGELINE GIDAYA (MD)
Entity type:Individual
Prefix:DR
First Name:EVANGELINE
Middle Name:GIDAYA
Last Name:ROXAS-BUTLIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501
Mailing Address - Country:US
Mailing Address - Phone:310-373-7855
Mailing Address - Fax:424-704-2493
Practice Address - Street 1:1727 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501
Practice Address - Country:US
Practice Address - Phone:310-373-7855
Practice Address - Fax:424-704-2493
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-01
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAA78060208000000X
CAA78060208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA78060Medicaid
CAA78060OtherCALIFORNIA LICENSE