MEDICARE: MARYSA HUNTER P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA50917	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA50917	OTHER	CA	PA LICENSE

General Provider Information

NPI Number	:	1326350935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYSA HUNTER P.A.

Provider Business Mailing Address
First Line	:	9300 N LOOP BLVD
Second Line	:	SUITE A&B
City	:	CALIFORNIA CITY
State	:	CA
Zip	:	93505-2269
Country	:	US
Telephone Number	:	760-373-1246
Fax Number	:	760-373-1214

Provider Business Practice Location Address
First Line	:	9300 N LOOP BLVD
Second Line	:	SUITE A&B
City	:	CALIFORNIA CITY
State	:	CA
Zip	:	93505-2269
Country	:	US
Telephone Number	:	760-373-1246
Fax Number	:	760-373-1214

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2010
Last Update Date	:	07/12/2010

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Directions to “ MARYSA HUNTER P.A.” Practice Location

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