Provider Demographics
NPI:1275406605
Name:BUNCE, ROBERT CHARLES
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:CHARLES
Last Name:BUNCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19401 SUSAN WAY
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-9266
Mailing Address - Country:US
Mailing Address - Phone:209-588-7018
Mailing Address - Fax:209-396-3345
Practice Address - Street 1:19331 SUSAN WAY
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-9209
Practice Address - Country:US
Practice Address - Phone:209-588-7018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility