Healthcare Provider Details

I. General information

NPI: 1477061125
Provider Name (Legal Business Name): ALBA TREJO ROSAS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MARIO CAPECCHI DRIVE 3RD FLOOR SOUTH
SALT LAKE CITY UT
84132-0002
US

IV. Provider business mailing address

30 N MARIO CAPECCHI DRIVE 3RD FLOOR SOUTH
SALT LAKE CITY UT
84132-0001
US

V. Phone/Fax

Practice location:
  • Phone: 801-585-3488
  • Fax:
Mailing address:
  • Phone: 801-585-2031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number10656650-1206
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10656650-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: