Provider Demographics
NPI:1386925204
Name:NUNN, ROBERT GREGORY (PHD, BCBA-D)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GREGORY
Last Name:NUNN
Suffix:
Gender:M
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11225 WOODRUSH LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-3605
Mailing Address - Country:US
Mailing Address - Phone:858-675-0065
Mailing Address - Fax:858-675-0065
Practice Address - Street 1:11225 WOODRUSH LN
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-3605
Practice Address - Country:US
Practice Address - Phone:858-675-0065
Practice Address - Fax:858-675-0065
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6881103K00000X, 103TC0700X, 103TM1800X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool