Healthcare Provider Details

I. General information

NPI: 1861109431
Provider Name (Legal Business Name): PRAVENTIO HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 S 400 E
BOUNTIFUL UT
84010-4938
US

IV. Provider business mailing address

7533 S CENTER VIEW CT STE R
WEST JORDAN UT
84084-5526
US

V. Phone/Fax

Practice location:
  • Phone: 305-707-7045
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIEL ANGERBAUER
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 305-707-7045