Healthcare Provider Details

I. General information

NPI: 1780367466
Provider Name (Legal Business Name): WASATCH MEDICAL CLINIC,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 W 9000 S
SANDY UT
84070-2049
US

IV. Provider business mailing address

235 W 9000 S
SANDY UT
84070-2049
US

V. Phone/Fax

Practice location:
  • Phone: 801-893-2682
  • Fax: 385-351-9686
Mailing address:
  • Phone: 801-893-2682
  • Fax: 385-351-9686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: WANDA MARIE SOLORIO
Title or Position: MANAGER
Credential: PA-C/FNP
Phone: 209-485-0954