Healthcare Provider Details

I. General information

NPI: 1083177505
Provider Name (Legal Business Name): VITOR GABRIEL GIULIANI ALCANTARA CARIOCA ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 SOUTH CAMPUS DRIVE
SALT LAKE CITY UT
84115
US

IV. Provider business mailing address

1850 SOUTH CAMPUS DRIVE
SALT LAKE CITY UT
84115
US

V. Phone/Fax

Practice location:
  • Phone: 304-704-1936
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: