Healthcare Provider Details

I. General information

NPI: 1194132837
Provider Name (Legal Business Name): JAY MICHAEL HUNTER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND ST
OAKLAND CA
94609-1809
US

IV. Provider business mailing address

695 GRAND VIEW AVE APT 203
SAN FRANCISCO CA
94114-3501
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3000
  • Fax:
Mailing address:
  • Phone: 817-682-0282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number95008903
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: