Healthcare Provider Details

I. General information

NPI: 1720629371
Provider Name (Legal Business Name): OWN MY HEALTH MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12371 900 E SUITE 102
DRAPER UT
84020
US

IV. Provider business mailing address

12371 900 E SUITE 102
DRAPER UT
84020
US

V. Phone/Fax

Practice location:
  • Phone: 385-247-0775
  • Fax:
Mailing address:
  • Phone: 385-247-0775
  • 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: DR. WARREN WILLEY
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 385-247-0775