Healthcare Provider Details

I. General information

NPI: 1568427052
Provider Name (Legal Business Name): CARMEN E GOTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 S 900 E STE 104
ST GEORGE UT
84790-7001
US

IV. Provider business mailing address

PO BOX 790128
VIRGIN UT
84779-0128
US

V. Phone/Fax

Practice location:
  • Phone: 435-292-6492
  • Fax: 434-355-3950
Mailing address:
  • Phone: 435-292-6492
  • Fax: 434-355-3950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number12719806-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12719806-1205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number35082592
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number76241
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: