Individual
ANNA BOUTTAVONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2633 E 27TH ST, OAKLAND, CA 94601-1912
(510) 535-5115
Mailing address
2600 STOCKTON BLVD, SACRAMENTO, CA 95817-2210
(916) 520-2785
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
95209212
CA
Other
Enumeration date
05/03/2022
Last updated
05/03/2022
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