MEDICARE: DR. ROBERT GREGORY NUNN PH.D., BCBA-D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	PSY6881	CA
2	103TC0700X	Clinical Psychologist	PSY6881	CA
3	103TM1800X	Intellectual & Developmental Disabilities Psychologist	PSY6881	CA
4	103TS0200X	School Psychologist	PSY6881	CA

General Provider Information

NPI Number	:	1386925204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT GREGORY NUNN PH.D., BCBA-D

Provider Business Mailing Address
First Line	:	11225 WOODRUSH LN
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-3605
Country	:	US
Telephone Number	:	858-675-0065
Fax Number	:	858-675-0065

Provider Business Practice Location Address
First Line	:	11225 WOODRUSH LN
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-3605
Country	:	US
Telephone Number	:	858-675-0065
Fax Number	:	858-675-0065

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2011
Last Update Date	:	09/06/2011

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