Healthcare Provider Details

I. General information

NPI: 1467718569
Provider Name (Legal Business Name): CATALINA MARIA JARAMILLO CASTRILLON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1125
US

IV. Provider business mailing address

81 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1125
US

V. Phone/Fax

Practice location:
  • Phone: 801-213-3599
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTL.0006943
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9376004-1205
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number9376004-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: