Healthcare Provider Details

I. General information

NPI: 1780252338
Provider Name (Legal Business Name): CRISTINA ANN CREAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 UNIVERSITY VLG
SALT LAKE CITY UT
84108-3523
US

IV. Provider business mailing address

1520 UNIVERSITY VLG
SALT LAKE CITY UT
84108-3523
US

V. Phone/Fax

Practice location:
  • Phone: 435-395-1097
  • Fax:
Mailing address:
  • Phone: 435-395-1097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number8804838-4402
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number8804838-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: