Healthcare Provider Details

I. General information

NPI: 1174870711
Provider Name (Legal Business Name): SHARLENE B. COOMBS R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MARIO CAPECCHI DR SUITE 2650
SALT LAKE CITY UT
84113-1103
US

IV. Provider business mailing address

100 MARIO CAPECCHI DR SUITE 2650
SALT LAKE CITY UT
84113-1103
US

V. Phone/Fax

Practice location:
  • Phone: 801-662-5319
  • Fax: 801-662-2912
Mailing address:
  • Phone: 801-662-5319
  • Fax: 801-662-2912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number1068414901
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: