Healthcare Provider Details

I. General information

NPI: 1336143924
Provider Name (Legal Business Name): JANEL ARBON RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 JUAN CT
MOAB UT
84532-2125
US

IV. Provider business mailing address

454 JUAN CT
MOAB UT
84532-2125
US

V. Phone/Fax

Practice location:
  • Phone: 435-259-1638
  • Fax: 435-651-3376
Mailing address:
  • Phone: 435-651-3291
  • Fax: 435-651-3376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number313051-4901
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: