Healthcare Provider Details

I. General information

NPI: 1104448026
Provider Name (Legal Business Name): AUBREY MOEDL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6910 S HIGHLAND DR
COTTONWOOD HEIGHTS UT
84121-3060
US

IV. Provider business mailing address

PO BOX 144
SALINAS CA
93902-0144
US

V. Phone/Fax

Practice location:
  • Phone: 801-308-9113
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: