Provider Demographics
NPI:1336631191
Name:HUNTER, PATTAYA
Entity type:Individual
Prefix:
First Name:PATTAYA
Middle Name:
Last Name:HUNTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13192 BRUNSWICK RD
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-9388
Mailing Address - Country:US
Mailing Address - Phone:530-273-0631
Mailing Address - Fax:916-504-4328
Practice Address - Street 1:13192 BRUNSWICK RD
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-9388
Practice Address - Country:US
Practice Address - Phone:530-273-0631
Practice Address - Fax:916-504-4328
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist