Healthcare Provider Details

I. General information

NPI: 1023943925
Provider Name (Legal Business Name): CHRISTOPHER ISLAS RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 S STATE ST UNIT 1001
SALT LAKE CITY UT
84111-3133
US

IV. Provider business mailing address

245 S STATE ST UNIT 1001
SALT LAKE CITY UT
84111-3133
US

V. Phone/Fax

Practice location:
  • Phone: 385-770-6973
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: