Healthcare Provider Details

I. General information

NPI: 1639665227
Provider Name (Legal Business Name): ANDREA LYNNE BUNKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2248 STOCKTON BLVD
SACRAMENTO CA
95817-1474
US

IV. Provider business mailing address

2230 STOCKTON BLVD
SACRAMENTO CA
95817-1353
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2614
  • Fax:
Mailing address:
  • Phone: 916-734-2614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number156670
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: