Provider Demographics
NPI:1760185151
Name:GHIOTTI, HUNTER RAY
Entity Type:Individual
Prefix:
First Name:HUNTER
Middle Name:RAY
Last Name:GHIOTTI
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 1:355 DAY VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-9542
Mailing Address - Country:US
Mailing Address - Phone:831-359-9117
Mailing Address - Fax:
Practice Address - Street 1:901 SOQUEL AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2122
Practice Address - Country:US
Practice Address - Phone:831-426-4303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA180862183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician