Provider Demographics
NPI:1831622760
Name:HUNTER, GRACE
Entity type:Individual
Prefix:
First Name:GRACE
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 1:727 DE SOTO DR
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-2807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:325 W CHANNEL ISLANDS BLVD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-4501
Practice Address - Country:US
Practice Address - Phone:802-204-9520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 251X00000X, 332U00000X, 385H00000X, 390200000X
CAA159887207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251X00000XAgenciesSupports Brokerage
No332U00000XSuppliersHome Delivered Meals
No385H00000XRespite Care FacilityRespite Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program