Provider Demographics
NPI:1598978132
Name:BUNTJER, KAREN L (RD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:L
Last Name:BUNTJER
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2464 MERRITT PL
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-6609
Mailing Address - Country:US
Mailing Address - Phone:925-292-0379
Mailing Address - Fax:
Practice Address - Street 1:5725 W LAS POSITAS BLVD
Practice Address - Street 2:SUITE#220
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-4054
Practice Address - Country:US
Practice Address - Phone:925-416-6730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
564053133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered