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NPI Code Detail

MEDICARE: ASIAN ASSOCIATION OF UTAH

MEDICARE: ASIAN ASSOCIATION OF UTAH
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
1252Y00000XEarly Intervention Provider Agency16713UT

General Provider Information

NPI Number : 1356659460
Entity Type Code : Organization
Provider Name (Legal Business Name) : ASIAN ASSOCIATION OF UTAH
Provider Business Mailing Address
First Line : 1588 MAJOR ST
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84115-1631
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1588 MAJOR ST
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84115-1631
Country : US
Telephone Number : 801-467-6060
Fax Number :
Authorized Official
Title or Position : CLINICAL SUPERVISOR
Name : BARRETT BONELLA
Credential :
Telephone Number : 801-467-6060
Provider Enumeration Date : 09/23/2010
Last Update Date : 09/23/2010

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Directions to “ASIAN ASSOCIATION OF UTAH ” Practice Location

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