Healthcare Provider Details

I. General information

NPI: 1386105062
Provider Name (Legal Business Name): BRIAN LUIS PANDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 03/09/2025
Certification Date: 03/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

273 E 10TH AVE
SALT LAKE CITY UT
84103-2531
US

IV. Provider business mailing address

273 E 10TH AVE
SALT LAKE CITY UT
84103-2531
US

V. Phone/Fax

Practice location:
  • Phone: 801-200-1050
  • Fax:
Mailing address:
  • Phone: 801-200-1050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101285046
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number13800185-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: