Healthcare Provider Details

I. General information

NPI: 1285216374
Provider Name (Legal Business Name): VANESSA L MOCK MAOM, L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8191 S 700 E
SANDY UT
84070-0519
US

IV. Provider business mailing address

3001 E LA JOYA DR
SALT LAKE CITY UT
84124-3753
US

V. Phone/Fax

Practice location:
  • Phone: 385-308-4355
  • Fax:
Mailing address:
  • Phone: 267-255-2299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number12165069-1201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: