Healthcare Provider Details

I. General information

NPI: 1730091364
Provider Name (Legal Business Name): DESERT BLOOM PEDIATRIC NEUROPSYCHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9139 W THUNDERBIRD RD STE 210
PEORIA AZ
85381-4923
US

IV. Provider business mailing address

9139 W THUNDERBIRD RD STE 210
PEORIA AZ
85381-4923
US

V. Phone/Fax

Practice location:
  • Phone: 623-738-4864
  • Fax:
Mailing address:
  • Phone: 623-738-4864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. NACONA BUNKER
Title or Position: PEDIATRIC NEUROPSYCHOLOGIST
Credential: PSYD
Phone: 623-738-4864