Healthcare Provider Details

I. General information

NPI: 1326345570
Provider Name (Legal Business Name): GABRIEL ENRIQUE MACIEL CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2011
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 W 500 S
SALT LAKE CITY UT
84104-5202
US

IV. Provider business mailing address

1640 W 500 S
SALT LAKE CITY UT
84104-5202
US

V. Phone/Fax

Practice location:
  • Phone: 385-499-5318
  • Fax: 801-886-0956
Mailing address:
  • Phone: 385-499-5318
  • Fax: 801-886-0956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number323844-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: