Provider Demographics
NPI:1588904684
Name:BUNAC, DIANA MAE ESTORES
Entity type:Individual
Prefix:
First Name:DIANA MAE
Middle Name:ESTORES
Last Name:BUNAC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:498 CASTRO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-2020
Mailing Address - Country:US
Mailing Address - Phone:415-861-3136
Mailing Address - Fax:650-861-0138
Practice Address - Street 1:498 CASTRO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-2020
Practice Address - Country:US
Practice Address - Phone:415-861-3136
Practice Address - Fax:650-861-0138
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA557183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician