Healthcare Provider Details

I. General information

NPI: 1417806043
Provider Name (Legal Business Name): MR. DANIEL CONTRERAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 CHIPETA WAY, SUITE 22
SALT LAKE CITY UT
84108
US

IV. Provider business mailing address

1328 S 1925 W
SYRACUSE UT
84075-6912
US

V. Phone/Fax

Practice location:
  • Phone: 801-425-4884
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: