Basic Information
| Provider Information | |||||||||
| NPI: | 1477194512 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NUNLEY | ||||||||
| FirstName: | DYLAN | ||||||||
| MiddleName: | SCOTT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 143 RHAME TER | ||||||||
| Address2: | |||||||||
| City: | SANTA PAULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930601526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054155016 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1722 S LEWIS RD | ||||||||
| Address2: | |||||||||
| City: | CAMARILLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930128520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8053664040 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2019 | ||||||||
| LastUpdateDate: | 06/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.