Healthcare Provider Details

I. General information

NPI: 1902500341
Provider Name (Legal Business Name): KRISTINE BUNALES RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. KRISTINE BUTZLOFF

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 03/29/2023
Certification Date: 03/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 W ORANGE AVE
ANAHEIM CA
92804-3156
US

IV. Provider business mailing address

3801 E PCH APT 321
LONG BEACH CA
90804
US

V. Phone/Fax

Practice location:
  • Phone: 714-827-3000
  • Fax:
Mailing address:
  • Phone: 562-618-9845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95256790
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: