Healthcare Provider Details

I. General information

NPI: 1376470773
Provider Name (Legal Business Name): RUTH C CASTANEDA CPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3269 S MAIN ST STE 100
SOUTH SALT LAKE UT
84115-3773
US

IV. Provider business mailing address

3269 S MAIN ST STE 100
SOUTH SALT LAKE UT
84115-3773
US

V. Phone/Fax

Practice location:
  • Phone: 801-935-4447
  • Fax:
Mailing address:
  • Phone: 801-935-4447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number2506
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: