Healthcare Provider Details

I. General information

NPI: 1770323214
Provider Name (Legal Business Name): RED ROCK C & C DRIP SPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3687 PIONEER PARKWAY #1
SANTA CLARA UT
84765
US

IV. Provider business mailing address

3687 PIONEER PARKWAY #1
SANTA CLARA UT
84765
US

V. Phone/Fax

Practice location:
  • Phone: 435-922-3747
  • Fax:
Mailing address:
  • Phone: 435-922-3747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN MARTIN
Title or Position: OWNER
Credential:
Phone: 435-922-3747