Healthcare Provider Details

I. General information

NPI: 1295762078
Provider Name (Legal Business Name): MICHAEL J HUNTLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7592 METROPOLITAN DR STE 404
SAN DIEGO CA
92108-4428
US

IV. Provider business mailing address

PO BOX 969096
SAN DIEGO CA
92196-9096
US

V. Phone/Fax

Practice location:
  • Phone: 619-325-1161
  • Fax: 619-325-1717
Mailing address:
  • Phone: 858-495-0971
  • Fax: 858-495-0991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG70722
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: