Provider Demographics
NPI:1699666107
Name:BUTLER, ANDRIA GLORIA (IBCLC)
Entity type:Individual
Prefix:
First Name:ANDRIA
Middle Name:GLORIA
Last Name:BUTLER
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3091 PALOMINO WAY
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-9267
Mailing Address - Country:US
Mailing Address - Phone:408-823-9929
Mailing Address - Fax:
Practice Address - Street 1:3091 PALOMINO WAY
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-9267
Practice Address - Country:US
Practice Address - Phone:408-823-9929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-12
Last Update Date:2025-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-319051174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty