Healthcare Provider Details

I. General information

NPI: 1679466650
Provider Name (Legal Business Name): MARIA FERNANDA RUBILAR VASQUEZ STUDENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 S 200 E
BOUNTIFUL UT
84010-5403
US

IV. Provider business mailing address

10 S 2000 E
SALT LAKE CITY UT
84112-5880
US

V. Phone/Fax

Practice location:
  • Phone: 385-231-6213
  • Fax:
Mailing address:
  • Phone: 801-581-3414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number12947385-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: