Healthcare Provider Details

I. General information

NPI: 1093649857
Provider Name (Legal Business Name): CARLOS ARIEL TITA RN, CDCES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

589 S STATE ST
PROVO UT
84606-5056
US

IV. Provider business mailing address

1778 W 950 S
SPRINGVILLE UT
84663-3544
US

V. Phone/Fax

Practice location:
  • Phone: 801-429-2000
  • Fax: 801-429-2001
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number11290048-3102
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number11290048-3102
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number11290048-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: