Healthcare Provider Details

I. General information

NPI: 1417813304
Provider Name (Legal Business Name): EMILIA MARIA DOS SANTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 NOVELL PL
PROVO UT
84606-6171
US

IV. Provider business mailing address

1800 NOVELL PL
PROVO UT
84606-6171
US

V. Phone/Fax

Practice location:
  • Phone: 801-375-5125
  • Fax:
Mailing address:
  • Phone: 801-375-5125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95298891
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: