Healthcare Provider Details

I. General information

NPI: 1720890882
Provider Name (Legal Business Name): NATHANIEL BUNTON RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 S MOUNT VERNON AVE STE 90
COLTON CA
92324-3928
US

IV. Provider business mailing address

930 S MOUNT VERNON AVE STE 90
COLTON CA
92324-3928
US

V. Phone/Fax

Practice location:
  • Phone: 909-252-7520
  • Fax: 909-252-7520
Mailing address:
  • Phone: 909-252-7520
  • Fax: 909-252-7520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-407635
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: