Healthcare Provider Details

I. General information

NPI: 1356984538
Provider Name (Legal Business Name): ZILLAH JULIANA MUSUNGU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3443 S STATE ST STE 7
SALT LAKE CITY UT
84115-4915
US

IV. Provider business mailing address

3443 S STATE ST STE 7
SALT LAKE CITY UT
84115-4915
US

V. Phone/Fax

Practice location:
  • Phone: 801-410-9493
  • Fax:
Mailing address:
  • Phone: 801-410-9493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number11493820-1714
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: