Healthcare Provider Details

I. General information

NPI: 1437053600
Provider Name (Legal Business Name): UNIVIA COMMUNITY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5495 S 4015 W
SALT LAKE CITY UT
84118-9441
US

IV. Provider business mailing address

5495 S 4015 W
SALT LAKE CITY UT
84118-9441
US

V. Phone/Fax

Practice location:
  • Phone: 801-414-2261
  • Fax:
Mailing address:
  • Phone: 801-414-2261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARIO VAZQUEZ
Title or Position: OWNER
Credential:
Phone: 801-414-2261