Provider Demographics
NPI:1710326806
Name:GAUTHIER, JUSTIN RAY
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:RAY
Last Name:GAUTHIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 CAMINO DEL REMEDIO BLDG 3
Mailing Address - Street 2:ADMHS
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-1332
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:315 CAMINO DEL REMEDIO BLDG 3
Practice Address - Street 2:ADMHS
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1332
Practice Address - Country:US
Practice Address - Phone:805-681-5244
Practice Address - Fax:805-681-4084
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program