Provider Demographics
NPI:1609968346
Name:BUNYAK, ALEXANDRA R (MD)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:R
Last Name:BUNYAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 N. EL CAMINO REAL
Mailing Address - Street 2:STE 504
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2815
Mailing Address - Country:US
Mailing Address - Phone:760-632-1090
Mailing Address - Fax:760-652-4825
Practice Address - Street 1:317 N. EL CAMINO REAL
Practice Address - Street 2:STE 504
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2815
Practice Address - Country:US
Practice Address - Phone:760-632-1090
Practice Address - Fax:760-652-4825
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78808208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA03-0431018OtherTRICARE
CAZZZ04918ZOtherBLU SHIELD
CAGR0093170Medicaid
CA86968Medicare UPIN
H86968Medicare UPIN
CAGR0093170Medicaid