Healthcare Provider Details

I. General information

NPI: 1275804940
Provider Name (Legal Business Name): SYMPTOM MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 03/21/2012
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 NORTH PACIFIC AVE SUITE F
SANTA CRUZ CA
95060-7602
US

V. Phone/Fax

Practice location:
  • Phone: 888-796-6331
  • Fax: 888-796-6330
Mailing address:
  • Phone: 888-796-6331
  • Fax: 888-796-6330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberA76678
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License NumberA76678
License Number StateCA

VIII. Authorized Official

Name: DR. CHANTE S BUNTIN
Title or Position: CEO
Credential: MD
Phone: 888-796-6331