Provider Demographics
NPI:1275804940
Name:SYMPTOM MEDICINE INC
Entity Type:Organization
Organization Name:SYMPTOM MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANTE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BUNTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-796-6331
Mailing Address - Street 1:2030 NORTH PACIFIC AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-7602
Mailing Address - Country:US
Mailing Address - Phone:888-796-6331
Mailing Address - Fax:888-796-6330
Practice Address - Street 1:2030 N PACIFIC AVE
Practice Address - Street 2:SUITE F
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-7602
Practice Address - Country:US
Practice Address - Phone:888-796-6331
Practice Address - Fax:888-796-6330
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHANTE S BUNTIN MD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-26
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76678261QM2500X, 261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA163078Medicare UPIN