Healthcare Provider Details

I. General information

NPI: 1336217793
Provider Name (Legal Business Name): JAVIER NORIEGA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 E MEDICAL CENTER DR # 109
ST GEORGE UT
84790-2123
US

IV. Provider business mailing address

1380 E MEDICAL CENTER DR # 109
ST GEORGE UT
84790-2123
US

V. Phone/Fax

Practice location:
  • Phone: 801-649-8810
  • Fax: 801-516-1418
Mailing address:
  • Phone: 801-649-8810
  • Fax: 801-516-1418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JAVIER NORIEGA
Title or Position: PRESIDENT
Credential:
Phone: 801-649-8810