Healthcare Provider Details

I. General information

NPI: 1225995293
Provider Name (Legal Business Name): JORELLE ANALI OBRIQUE BALAHADIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 S GENEVA RD
OREM UT
84058-5857
US

IV. Provider business mailing address

19 W 1200 S
KAYSVILLE UT
84037-2843
US

V. Phone/Fax

Practice location:
  • Phone: 801-863-7982
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: