Healthcare Provider Details

I. General information

NPI: 1043148885
Provider Name (Legal Business Name): IZABELLA MARION SILVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 W BROADWAY STE 700
SALT LAKE CITY UT
84101-2060
US

IV. Provider business mailing address

136 W 200 S APT 118
PROVO UT
84601-5919
US

V. Phone/Fax

Practice location:
  • Phone: 385-494-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-410806
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: