Healthcare Provider Details

I. General information

NPI: 1336922525
Provider Name (Legal Business Name): ANNA MARIE HERNANDEZ-RAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 S 1100 E STE 202
SALT LAKE CITY UT
84106-4092
US

IV. Provider business mailing address

1010 E EMERSON AVE
SALT LAKE CITY UT
84105-2416
US

V. Phone/Fax

Practice location:
  • Phone: 801-386-0278
  • Fax:
Mailing address:
  • Phone: 801-386-0278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number12621793-1103
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License Number12621793-1103
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: