Healthcare Provider Details

I. General information

NPI: 1851416010
Provider Name (Legal Business Name): TONY S HUNT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9405 FAIRWAY VIEW PL
RANCHO CUCAMONGA CA
91730-0932
US

IV. Provider business mailing address

9405 FAIRWAY VIEW PL
RANCHO CUCAMONGA CA
91730-0932
US

V. Phone/Fax

Practice location:
  • Phone: 909-481-7345
  • Fax: 909-484-8661
Mailing address:
  • Phone: 909-481-7345
  • Fax: 909-484-8661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberGO67444
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG067444
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: