Healthcare Provider Details

I. General information

NPI: 1548123797
Provider Name (Legal Business Name): DANIEL JAMES MORELAND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 N 2100 W
SALT LAKE CITY UT
84116-2991
US

IV. Provider business mailing address

130 N 2100 W
SALT LAKE CITY UT
84116-2991
US

V. Phone/Fax

Practice location:
  • Phone: 385-430-2112
  • Fax:
Mailing address:
  • Phone: 385-430-2112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberF25-131054
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: