Healthcare Provider Details

I. General information

NPI: 1245557966
Provider Name (Legal Business Name): JOSHUA VIJAYANAND JABEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LDS HOSPITAL 8TH AVE & C ST
SALT LAKE CITY UT
84143-0001
US

IV. Provider business mailing address

3127 S 500 E
SALT LAKE CITY UT
84106-1238
US

V. Phone/Fax

Practice location:
  • Phone: 801-408-5060
  • Fax:
Mailing address:
  • Phone: 909-255-6840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301510666
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number8134342-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: