Healthcare Provider Details

I. General information

NPI: 1972394666
Provider Name (Legal Business Name): BAILEE NIKOLE MINHONDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 E 5350 S STE 103
OGDEN UT
84405-6901
US

IV. Provider business mailing address

425 E 5350 S STE 103
OGDEN UT
84405-6901
US

V. Phone/Fax

Practice location:
  • Phone: 385-298-0818
  • Fax: 801-206-4354
Mailing address:
  • Phone: 385-298-0818
  • Fax: 801-206-4354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12296737-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: