Healthcare Provider Details

I. General information

NPI: 1497264949
Provider Name (Legal Business Name): MILAGROS GARGUREVICH PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. MILAGROS GARGUREVICH

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7321 BALMER ST BLDG 545
HILL AFB UT
84056-5012
US

IV. Provider business mailing address

7321 BALMER ST BLDG 545
HILL AFB UT
84056-5012
US

V. Phone/Fax

Practice location:
  • Phone: 801-777-7909
  • Fax:
Mailing address:
  • Phone: 801-777-7909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number60939923
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: