Healthcare Provider Details

I. General information

NPI: 1316864226
Provider Name (Legal Business Name): ROSALVA GUERRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

667 S 700 E
SALT LAKE CITY UT
84102-3441
US

IV. Provider business mailing address

667 S 700 E
SALT LAKE CITY UT
84102-3441
US

V. Phone/Fax

Practice location:
  • Phone: 385-310-4504
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number14283435-3101
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: