Healthcare Provider Details
I. General information
NPI: 1073313995
Provider Name (Legal Business Name): RSLNT WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 03/18/2025
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1371 BUSINESS PARK DR STE 100
OREM UT
84058-2252
US
IV. Provider business mailing address
1981 W 475 S
OREM UT
84059-2616
US
V. Phone/Fax
- Phone: 385-866-3129
- Fax:
- Phone: 808-897-5155
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2084P0800X |
| Taxonomy | Psychiatry Physician |
| License Number | |
| License Number State | |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
VIII. Authorized Official
Name:
ISAAC
TOLEAFOA
Title or Position: OWNER/MANAGER
Credential:
Phone: 808-897-5155