Healthcare Provider Details

I. General information

NPI: 1285244459
Provider Name (Legal Business Name): ANGEL REY CANO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 02/15/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 S 5600 S SUITE 110
MURRAY UT
84107-3060
US

IV. Provider business mailing address

201 E VINE ST APT 2
SALT LAKE CITY UT
84107-5222
US

V. Phone/Fax

Practice location:
  • Phone: 801-600-0308
  • Fax:
Mailing address:
  • Phone: 562-210-9240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: