Healthcare Provider Details

I. General information

NPI: 1346824224
Provider Name (Legal Business Name): ALFREDO ABRAHAM ARAUJO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 LINCOLN AVE
OGDEN UT
84404-5638
US

IV. Provider business mailing address

3462 S 620 W
NIBLEY UT
84321-6285
US

V. Phone/Fax

Practice location:
  • Phone: 801-621-6510
  • Fax:
Mailing address:
  • Phone: 435-224-2606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: