Healthcare Provider Details

I. General information

NPI: 1336631191
Provider Name (Legal Business Name): PATTAYA HUNTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13192 BRUNSWICK RD
GRASS VALLEY CA
95945-9388
US

IV. Provider business mailing address

13192 BRUNSWICK RD
GRASS VALLEY CA
95945-9388
US

V. Phone/Fax

Practice location:
  • Phone: 530-273-0631
  • Fax: 916-504-4328
Mailing address:
  • Phone: 530-273-0631
  • Fax: 916-504-4328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: