Provider Demographics
NPI:1265658835
Name:BUNKIS, JURIS (MD,FACS)
Entity Type:Individual
Prefix:DR
First Name:JURIS
Middle Name:
Last Name:BUNKIS
Suffix:
Gender:M
Credentials:MD,FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22342 AVENIDA EMPRESA
Mailing Address - Street 2:SUITE 175
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-2140
Mailing Address - Country:US
Mailing Address - Phone:949-888-9700
Mailing Address - Fax:949-888-9724
Practice Address - Street 1:22342 AVENIDA EMPRESA
Practice Address - Street 2:SUITE 175
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2140
Practice Address - Country:US
Practice Address - Phone:949-888-9700
Practice Address - Fax:949-888-9724
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC39906174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist