Healthcare Provider Details

I. General information

NPI: 1093657918
Provider Name (Legal Business Name): MATTHEW CERTONIO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 E MEDICAL CENTER DR
ST GEORGE UT
84790-2123
US

IV. Provider business mailing address

814 W 1300 NORTH CIR
ST GEORGE UT
84770-2653
US

V. Phone/Fax

Practice location:
  • Phone: 435-251-1000
  • Fax:
Mailing address:
  • Phone: 801-602-6480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10836619-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: