Healthcare Provider Details

I. General information

NPI: 1366767147
Provider Name (Legal Business Name): KATHY STRETCH GARCIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHY LYND STRETCH

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3556 W 9800 S STE 101
SOUTH JORDAN UT
84095
US

IV. Provider business mailing address

3556 W 9800 S STE 101
SOUTH JORDAN UT
84095-3221
US

V. Phone/Fax

Practice location:
  • Phone: 801-567-9780
  • Fax: 801-567-9826
Mailing address:
  • Phone: 801-567-9780
  • Fax: 801-567-9826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4824557-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: