Healthcare Provider Details

I. General information

NPI: 1457653024
Provider Name (Legal Business Name): JANEAL RAE IRISH-MADRUGA COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 COTTONWOOD ST
MURRAY UT
84107-5701
US

IV. Provider business mailing address

5121 COTTONWOOD ST
MURRAY UT
84107-5701
US

V. Phone/Fax

Practice location:
  • Phone: 801-380-0213
  • Fax:
Mailing address:
  • Phone: 801-380-0213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4880407-4202
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: