Provider Demographics
NPI:1194290833
Name:GUNNER, MICHELLE (RBT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:GUNNER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:BONILLA TRUJILLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RBT
Mailing Address - Street 1:3934 MURPHY CANYON RD STE B202
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4437
Mailing Address - Country:US
Mailing Address - Phone:619-281-6067
Mailing Address - Fax:619-795-0814
Practice Address - Street 1:3934 MURPHY CANYON RD STE B202
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4437
Practice Address - Country:US
Practice Address - Phone:619-281-6067
Practice Address - Fax:619-795-0814
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17-29169106S00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician