Healthcare Provider Details

I. General information

NPI: 1487547782
Provider Name (Legal Business Name): VICTORIA P CANO SOTELO LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 W 1800 N STE A
CLINTON UT
84015-8503
US

IV. Provider business mailing address

1808 W 1800 N STE A
CLINTON UT
84015-8503
US

V. Phone/Fax

Practice location:
  • Phone: 801-217-3133
  • Fax: 801-528-5066
Mailing address:
  • Phone: 801-217-3133
  • Fax: 801-528-5066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14218484-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: