Provider Demographics
NPI:1457162356
Name:BUNTON, RAKO BATRICE
Entity type:Individual
Prefix:
First Name:RAKO
Middle Name:BATRICE
Last Name:BUNTON
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 1:1704 W MANCHESTER AVE STE 209D
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-3057
Mailing Address - Country:US
Mailing Address - Phone:323-961-1008
Mailing Address - Fax:323-967-9000
Practice Address - Street 1:1704 W MANCHESTER AVE STE 209D
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-3057
Practice Address - Country:US
Practice Address - Phone:323-961-1008
Practice Address - Fax:323-967-9000
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC3464076342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company