Healthcare Provider Details

I. General information

NPI: 1457162356
Provider Name (Legal Business Name): RAKO BATRICE BUNTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 01/20/2025
Certification Date: 01/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 W MANCHESTER AVE STE 209D
LOS ANGELES CA
90047-3057
US

IV. Provider business mailing address

1704 W MANCHESTER AVE STE 209D
LOS ANGELES CA
90047-3057
US

V. Phone/Fax

Practice location:
  • Phone: 323-961-1008
  • Fax: 323-967-9000
Mailing address:
  • Phone: 323-961-1008
  • Fax: 323-967-9000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License NumberC3464076
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: