Provider Demographics
NPI:1801141312
Name:BUNTING, STEVEN CODY (SOIDC)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:CODY
Last Name:BUNTING
Suffix:
Gender:M
Credentials:SOIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80397 MOONSHADOW DR
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5259
Mailing Address - Country:US
Mailing Address - Phone:205-427-2467
Mailing Address - Fax:
Practice Address - Street 1:80397 MOONSHADOW DR
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5259
Practice Address - Country:US
Practice Address - Phone:205-427-2467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman