Healthcare Provider Details

I. General information

NPI: 1891560462
Provider Name (Legal Business Name): ENOCH BLATNICK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2023
Last Update Date: 11/23/2023
Certification Date: 11/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1958 E SUNSET DR
LAYTON UT
84040-5711
US

IV. Provider business mailing address

1958 E SUNSET DR
LAYTON UT
84040-5711
US

V. Phone/Fax

Practice location:
  • Phone: 801-656-7781
  • Fax:
Mailing address:
  • Phone: 801-656-7781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1103X
TaxonomyResearch Study Abstracter/Coder
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: