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General NPI Number Information
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NPI Number | 1265785588
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Entity Type | Individual
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Provider Name | JONATHAN EDWARD BRUNO B.C.B.A.
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Gender | Male
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Dates
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Enumeration Date | 10/24/2012
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Last Update Date | 05/18/2021
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Provider Practice Location Address
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Address Line | 2825 W RUMBLE RD
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City | MODESTO
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State | CA
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Zip | 95350-0185
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Country | US
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Telephone | 209-222-2378
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Fax | 209-579-9494
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Provider Business Mailing Address
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Address Line | 2630 W RUMBLE RD
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City | MODESTO
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State | CA
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Zip | 95350-0155
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Country | US
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Telephone | 209-222-2378
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Fax | 209-579-9494
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-10-6985
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License Number State | CA
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