Healthcare Provider Details

I. General information

NPI: 1861709404
Provider Name (Legal Business Name): MARIA CONCEPCION VALDIZAN-GARCIA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8446 S HARRISON ST
MIDVALE UT
84047-3501
US

IV. Provider business mailing address

395 E 1200 N
OREM UT
84057-2711
US

V. Phone/Fax

Practice location:
  • Phone: 801-417-0131
  • Fax: 801-255-5814
Mailing address:
  • Phone: 210-875-4486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number718791
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8227016-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: