MEDICARE: KARLA F. VAZQUEZ- DE JESUS MD

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	2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	12751737-1205	UT

General Provider Information

NPI Number	:	1144883364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARLA F. VAZQUEZ- DE JESUS MD

Provider Business Mailing Address
First Line	:	295 S CHIPETA WAY
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1287
Country	:	US
Telephone Number	:	801-587-7450
Fax Number	:

Provider Business Practice Location Address
First Line	:	295 S CHIPETA WAY
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1287
Country	:	US
Telephone Number	:	801-587-7450
Fax Number	:

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

Provider Enumeration Date	:	04/15/2019
Last Update Date	:	03/09/2026

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