Healthcare Provider Details

I. General information

NPI: 1144052218
Provider Name (Legal Business Name): RUBICON HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1536 WOODLAND PARK DR STE 210
LAYTON UT
84041-5620
US

IV. Provider business mailing address

1536 WOODLAND PARK DR STE 210
LAYTON UT
84041-5620
US

V. Phone/Fax

Practice location:
  • Phone: 385-393-7486
  • Fax:
Mailing address:
  • Phone: 385-393-7486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: IAN HESS
Title or Position: MANAGER
Credential:
Phone: 385-393-7486