Healthcare Provider Details

I. General information

NPI: 1952224487
Provider Name (Legal Business Name): ANDREW BUNOTI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 BROOKWOOD AVE
SANTA ROSA CA
95404-5205
US

IV. Provider business mailing address

326 BROOKWOOD AVE
SANTA ROSA CA
95404-5205
US

V. Phone/Fax

Practice location:
  • Phone: 770-289-0427
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number709117
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: