Healthcare Provider Details

I. General information

NPI: 1790248219
Provider Name (Legal Business Name): SANDY HERMOSA MAS-SOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 700 E SUITE 2A
SALT LAKE CITY UT
84102
US

IV. Provider business mailing address

4715 S HANAUER ST APT 3
MURRAY UT
84107-3742
US

V. Phone/Fax

Practice location:
  • Phone: 800-434-8923
  • Fax:
Mailing address:
  • Phone: 787-675-8868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number14309868-2506
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-82935
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: