MEDICARE: JUSTIN CAUNTAY D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	20A9470	CA

General Provider Information

NPI Number	:	1346431483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN CAUNTAY D.O.

Provider Business Mailing Address
First Line	:	3471 REGIONAL PKWY
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-8209
Country	:	US
Telephone Number	:	707-575-5180
Fax Number	:

Provider Business Practice Location Address
First Line	:	3471 REGIONAL PKWY
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-8209
Country	:	US
Telephone Number	:	707-575-5180
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	08/05/2007

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Directions to “ JUSTIN CAUNTAY D.O.” Practice Location

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