Healthcare Provider Details

I. General information

NPI: 1598672321
Provider Name (Legal Business Name): BENJAMIN HERRICK GRANDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 E COTTONWOOD PKWY STE 500
SALT LAKE CITY UT
84121-7060
US

IV. Provider business mailing address

7735 S 2325 E
COTTONWOOD HEIGHTS UT
84121-5668
US

V. Phone/Fax

Practice location:
  • Phone: 385-388-2727
  • Fax:
Mailing address:
  • Phone: 385-388-2727
  • 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: