Healthcare Provider Details

I. General information

NPI: 1972438802
Provider Name (Legal Business Name): MARLENE CORONA GODINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3761 S DEER VALLEY DR SPC 149
MAGNA UT
84044-3033
US

IV. Provider business mailing address

3761 S DEER VALLEY DR SPC 149
MAGNA UT
84044-3033
US

V. Phone/Fax

Practice location:
  • Phone: 801-793-0871
  • Fax:
Mailing address:
  • Phone: 801-793-0871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: