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General NPI Number Information
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NPI Number | 1134062672
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Entity Type | Individual
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Provider Name | LAVANTE LORENZO BUSHNELL
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Gender | Male
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Dates
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Enumeration Date | 04/10/2026
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Last Update Date | 04/10/2026
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Provider Practice Location Address
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Address Line | 3610 SNELL AVE
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City | SAN JOSE
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State | CA
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Zip | 95136-1305
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Country | US
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Telephone | 888-227-1211
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Fax |
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Provider Business Mailing Address
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Address Line | 4777 GROUSE RUN DR APT 152
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City | STOCKTON
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State | CA
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Zip | 95207-5378
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Country | US
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Telephone | 209-670-6156
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | CA
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