Provider Demographics
NPI:1508890930
Name:BUNCE, JON (PHD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:
Last Name:BUNCE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:MRS
Other - First Name:ROSE MARY
Other - Middle Name:
Other - Last Name:BUNCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:118 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-3421
Mailing Address - Country:US
Mailing Address - Phone:209-384-0414
Mailing Address - Fax:209-384-1562
Practice Address - Street 1:118 PARK AVE
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-3421
Practice Address - Country:US
Practice Address - Phone:209-384-0414
Practice Address - Fax:209-384-1562
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10265103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL102650Medicare UPIN