Healthcare Provider Details

I. General information

NPI: 1336054774
Provider Name (Legal Business Name): CYNTHIA VERONICA WHITE CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA VERONICA MARTINEZ

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FOOTHILL DR BLDG 16
SALT LAKE CITY UT
84148-0001
US

IV. Provider business mailing address

1777 W 4650 S APT C
ROY UT
84067-3643
US

V. Phone/Fax

Practice location:
  • Phone: 801-582-1565
  • Fax:
Mailing address:
  • Phone: 956-900-6464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14277426-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: