MEDICARE: DIANA SMITH

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	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1760247878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA SMITH

Provider Business Mailing Address
First Line	:	7494 S 2135 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-4970
Country	:	US
Telephone Number	:	801-512-9444
Fax Number	:

Provider Business Practice Location Address
First Line	:	7494 S 2135 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-4970
Country	:	US
Telephone Number	:	801-512-9444
Fax Number	:

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

Provider Enumeration Date	:	02/19/2024
Last Update Date	:	02/19/2024

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Directions to “ DIANA SMITH ” Practice Location

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