Healthcare Provider Details

I. General information

NPI: 1770160970
Provider Name (Legal Business Name): ELMIRA AHNOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 N 1100 E STE 202
AMERICAN FORK UT
84003-2941
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-492-2510
  • Fax:
Mailing address:
  • Phone: 801-492-2510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number14283288-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: