Provider Demographics
NPI:1174052898
Name:BUNKER, DANIEL PAUL
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:PAUL
Last Name:BUNKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 N TOWNE AVE UNIT 57
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2449
Mailing Address - Country:US
Mailing Address - Phone:801-616-2968
Mailing Address - Fax:
Practice Address - Street 1:2410 N TOWNE AVE UNIT 57
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2449
Practice Address - Country:US
Practice Address - Phone:801-616-2968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant