Healthcare Provider Details

I. General information

NPI: 1154246809
Provider Name (Legal Business Name): FABIEN UBARIJORO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12558 S PONY EXPRESS RD APT 159
DRAPER UT
84020-1914
US

IV. Provider business mailing address

12558 S PONY EXPRESS RD APT 159
DRAPER UT
84020-1914
US

V. Phone/Fax

Practice location:
  • Phone: 725-780-5139
  • Fax:
Mailing address:
  • Phone: 725-780-5139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224ZR0403X
TaxonomyDriving and Community Mobility Occupational Therapy Assistant
License Number14721827-0160
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: