Healthcare Provider Details

I. General information

NPI: 1841803699
Provider Name (Legal Business Name): SERENA BUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2020
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date: 09/23/2021
Reactivation Date: 10/20/2021

III. Provider practice location address

66 S SAN ANTONIO RD
GOLETA CA
93110-1720
US

IV. Provider business mailing address

66 S SAN ANTONIO RD
GOLETA CA
93110-1720
US

V. Phone/Fax

Practice location:
  • Phone: 805-947-5175
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: