Healthcare Provider Details

I. General information

NPI: 1568826048
Provider Name (Legal Business Name): UNIVERSITY OF UTAH PEDIATRIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
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

PO BOX 841450
LOS ANGELES CA
90084-1450
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-6336
  • Fax:
Mailing address:
  • Phone: 801-213-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMUEL FINLAYSON
Title or Position: CHIEF CLINICAL OFFICER
Credential: MD
Phone: 801-587-6336