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General NPI Number Information
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NPI Number | 1730091364
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Entity Type | Organization
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Legal Business Name | DESERT BLOOM PEDIATRIC NEUROPSYCHOLOGY LLC
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Dates
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Enumeration Date | 09/18/2026
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Last Update Date | 09/18/2026
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Provider Practice Location Address
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Address Line | 9139 W THUNDERBIRD RD STE 210
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City | PEORIA
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State | AZ
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Zip | 85381-4923
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Country | US
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Telephone | 623-738-4864
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Fax |
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Provider Business Mailing Address
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Address Line | 9139 W THUNDERBIRD RD STE 210
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City | PEORIA
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State | AZ
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Zip | 85381-4923
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Country | US
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Telephone | 623-738-4864
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC NEUROPSYCHOLOGIST
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Name | DR. NACONA BUNKER
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Credential | PSYD
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Telephone | 623-738-4864
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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