Healthcare Provider Details

I. General information

NPI: 1508401183
Provider Name (Legal Business Name): RAUL RIOS RAYA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2019
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11650 S STATE ST STE 104
DRAPER UT
84020-7144
US

IV. Provider business mailing address

42 N PERTH ST
SARATOGA SPRINGS UT
84043-3280
US

V. Phone/Fax

Practice location:
  • Phone: 801-867-3472
  • Fax: 801-306-6353
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: