Healthcare Provider Details

I. General information

NPI: 1609334911
Provider Name (Legal Business Name): SANTIBANEZ AGUIRRE SLC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 E SOUTH TEMPLE
SALT LAKE CITY UT
84102-1507
US

IV. Provider business mailing address

111 W TELEGRAPH ST STE 200
CARSON CITY NV
89703-4189
US

V. Phone/Fax

Practice location:
  • Phone: 801-350-4111
  • Fax:
Mailing address:
  • Phone: 800-405-0076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSE A AGUIRRE
Title or Position: PRESIDENT
Credential: MD
Phone: 800-405-0076