Healthcare Provider Details

I. General information

NPI: 1992355630
Provider Name (Legal Business Name): EAST WEST HEALTH PLEASANT GROVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2019
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11020 N 5500 W # 101
HIGHLAND UT
84003-9643
US

IV. Provider business mailing address

471 E 1000 S STE C
PLEASANT GROVE UT
84062-3694
US

V. Phone/Fax

Practice location:
  • Phone: 801-829-7772
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: REGAN ARCHIBALD
Title or Position: OWNER
Credential:
Phone: 435-640-1353