MEDICARE: CLINICA MI SALUD LLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1487326195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICA MI SALUD LLC

Provider Business Mailing Address
First Line	:	2470 S REDWOOD RD STE 208
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-2197
Country	:	US
Telephone Number	:	801-214-0500
Fax Number	:	801-214-0600

Provider Business Practice Location Address
First Line	:	2470 S REDWOOD RD STE 208
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-2197
Country	:	US
Telephone Number	:	801-214-0500
Fax Number	:	801-214-0600

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	ISRAEL ALARCON
Credential	:
Telephone Number	:	801-897-9939

Provider Enumeration Date	:	09/30/2021
Last Update Date	:	09/30/2021

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