Basic Information
| Provider Information | |||||||||
| NPI: | 1205171972 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUNT | ||||||||
| FirstName: | ABIGAIL | ||||||||
| MiddleName: | RYAN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3110 CAMINO DEL RIO S STE 307 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921083832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6197959925 | ||||||||
| FaxNumber: | 8776025087 | ||||||||
| Practice Location | |||||||||
| Address1: | 3110 CAMINO DEL RIO S STE 307 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921083832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6197959925 | ||||||||
| FaxNumber: | 8776025087 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2012 | ||||||||
| LastUpdateDate: | 01/22/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.