Healthcare Provider Details

I. General information

NPI: 1437579869
Provider Name (Legal Business Name): KE'ALA MARY CABULAGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5770 S 250 E STE 300
MURRAY UT
84107-8110
US

IV. Provider business mailing address

10993 S PORCINI DR
SOUTH JORDAN UT
84009-4856
US

V. Phone/Fax

Practice location:
  • Phone: 801-314-2500
  • Fax:
Mailing address:
  • Phone: 435-272-3202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: