Healthcare Provider Details

I. General information

NPI: 1740920206
Provider Name (Legal Business Name): HAYDE BLANCO GUERRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5242 S COLLEGE DR STE 200
MURRAY UT
84123-2918
US

IV. Provider business mailing address

5242 S COLLEGE DR STE 200
MURRAY UT
84123-2918
US

V. Phone/Fax

Practice location:
  • Phone: 385-246-5971
  • Fax:
Mailing address:
  • Phone: 385-246-5971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number14186613-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: