Healthcare Provider Details

I. General information

NPI: 1508890930
Provider Name (Legal Business Name): JON BUNCE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MRS. ROSE MARY BUNCE

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 PARK AVE
MERCED CA
95348-3421
US

IV. Provider business mailing address

118 PARK AVE
MERCED CA
95348-3421
US

V. Phone/Fax

Practice location:
  • Phone: 209-384-0414
  • Fax: 209-384-1562
Mailing address:
  • Phone: 209-384-0414
  • Fax: 209-384-1562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10265
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: