Healthcare Provider Details

I. General information

NPI: 1629268826
Provider Name (Legal Business Name): CHANTE S. BUNTIN, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 04/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 N PACIFIC AVE SUITE F
SANTA CRUZ CA
95060-7602
US

IV. Provider business mailing address

2030 N PACIFIC AVE SUITE F
SANTA CRUZ CA
95060-7602
US

V. Phone/Fax

Practice location:
  • Phone: 831-251-1338
  • Fax:
Mailing address:
  • Phone: 831-251-1338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA76678
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA76678
License Number StateCA

VIII. Authorized Official

Name: CHANTE S BUNTIN
Title or Position: CEO
Credential: M.D.
Phone: 831-251-1338