Healthcare Provider Details

I. General information

NPI: 1316757784
Provider Name (Legal Business Name): JAIDEN ELISE GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 E EXECUTIVE PARK DR STE 923F
MURRAY UT
84117-7263
US

IV. Provider business mailing address

6571 S 2300 E
SALT LAKE CITY UT
84121-2628
US

V. Phone/Fax

Practice location:
  • Phone: 385-770-9866
  • Fax:
Mailing address:
  • Phone: 385-770-9866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number11429698-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: