Healthcare Provider Details

I. General information

NPI: 1912939786
Provider Name (Legal Business Name): ALPINE PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1912 W 930 N
PLEASANT GROVE UT
84062-4104
US

IV. Provider business mailing address

1912 W 930 N
PLEASANT GROVE UT
84062-4104
US

V. Phone/Fax

Practice location:
  • Phone: 801-492-1999
  • Fax: 801-922-9370
Mailing address:
  • Phone: 801-492-1999
  • Fax: 801-922-9370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON JAUSSI
Title or Position: ADMINISTRATOR
Credential:
Phone: 801-922-9371