Healthcare Provider Details

I. General information

NPI: 1760610349
Provider Name (Legal Business Name): CARISSA S MONROY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARISSA SORENSEN MD

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S 200 E STE 250
SALT LAKE CITY UT
84111-3846
US

IV. Provider business mailing address

660 S 200 E STE 250
SALT LAKE CITY UT
84111-3846
US

V. Phone/Fax

Practice location:
  • Phone: 801-359-2256
  • Fax:
Mailing address:
  • Phone: 801-359-2256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number74191611205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: