Healthcare Provider Details

I. General information

NPI: 1679406664
Provider Name (Legal Business Name): MARIA FERNANDA SOBERON AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3007 S WEST TEMPLE
SOUTH SALT LAKE UT
84115-3762
US

IV. Provider business mailing address

277 W BEVERLEE ANN DR
DRAPER UT
84020-6875
US

V. Phone/Fax

Practice location:
  • Phone: 801-244-0147
  • Fax:
Mailing address:
  • Phone: 801-244-0147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number14281949-3904
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: