Healthcare Provider Details

I. General information

NPI: 1316653520
Provider Name (Legal Business Name): VIVICA MALDONADO RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9815 S MONROE ST STE 400
SANDY UT
84070-4297
US

IV. Provider business mailing address

9815 S MONROE ST STE 400
SANDY UT
84070-4297
US

V. Phone/Fax

Practice location:
  • Phone: 801-401-4271
  • Fax:
Mailing address:
  • Phone: 801-401-4271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-256072
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License NumberRBT-23-256072
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: