Healthcare Provider Details

I. General information

NPI: 1063914125
Provider Name (Legal Business Name): OLIVIA HUNTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 CAMINO DEL RIO S STE 100
SAN DIEGO CA
92108
US

IV. Provider business mailing address

2820 CAMINO DEL RIO S STE 100
SAN DIEGO CA
92108-3822
US

V. Phone/Fax

Practice location:
  • Phone: 858-264-5858
  • Fax:
Mailing address:
  • Phone: 858-264-5858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: