Healthcare Provider Details

I. General information

NPI: 1831289438
Provider Name (Legal Business Name): EVELYN VALENCERINA GOPEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MEDICAL DR
SALT LAKE CITY UT
84132-0001
US

IV. Provider business mailing address

PO BOX 58294
SALT LAKE CITY UT
84158-0294
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-2507
  • Fax:
Mailing address:
  • Phone: 801-587-4330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number339897-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: