Healthcare Provider Details

I. General information

NPI: 1467388942
Provider Name (Legal Business Name): LUIS IGNACIO AGUIRRE QUINTANA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W BELLWOOD LN STE 1
SALT LAKE CITY UT
84123-4494
US

IV. Provider business mailing address

1000 W BELLWOOD LN STE 1
SALT LAKE CITY UT
84123-4494
US

V. Phone/Fax

Practice location:
  • Phone: 801-669-8176
  • Fax:
Mailing address:
  • Phone: 801-669-8176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberUT013833801546
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: