Provider Demographics
NPI:1659451573
Name:BUNTIN, CHANTE SIMONE (MD)
Entity Type:Individual
Prefix:
First Name:CHANTE
Middle Name:SIMONE
Last Name:BUNTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHANTE
Other - Middle Name:SIMONE
Other - Last Name:BUNTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
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:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76678207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8528143Medicaid
WA8528143Medicaid
WA8877455Medicare PIN