Provider Demographics
NPI:1932592342
Name:BUNTING, VIVIANA
Entity Type:Individual
Prefix:
First Name:VIVIANA
Middle Name:
Last Name:BUNTING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VIVIANA
Other - Middle Name:
Other - Last Name:ANDRADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27851 BRADLEY RD
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92586-2286
Mailing Address - Country:US
Mailing Address - Phone:951-821-6312
Mailing Address - Fax:
Practice Address - Street 1:27851 130L BRADLEY RD
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92586-2286
Practice Address - Country:US
Practice Address - Phone:951-821-6312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF81979106H00000X
CALMFT99648106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist