Healthcare Provider Details

I. General information

NPI: 1053241091
Provider Name (Legal Business Name): JUAN MIGUEL GARRIDO BALMEDINA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13129 S TOWER RIDGE DR APT B206
RIVERTON UT
84096-2723
US

IV. Provider business mailing address

13129 S TOWER RIDGE DR APT B206
RIVERTON UT
84096-2723
US

V. Phone/Fax

Practice location:
  • Phone: 360-591-3319
  • Fax:
Mailing address:
  • Phone: 360-591-3319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: