Provider Demographics
NPI:1629268826
Name:CHANTE S. BUNTIN, M.D., INC.
Entity Type:Organization
Organization Name:CHANTE S. BUNTIN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
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:831-251-1338
Mailing Address - Street 1:2030 N 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:831-251-1338
Mailing Address - Fax:
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:831-251-1338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76678207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty