Healthcare Provider Details

I. General information

NPI: 1619882362
Provider Name (Legal Business Name): EQUINE HEALING HEARTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1089 S 1500 W
VERNAL UT
84078-4622
US

IV. Provider business mailing address

1089 S 1500 W
VERNAL UT
84078-4622
US

V. Phone/Fax

Practice location:
  • Phone: 801-636-1007
  • Fax:
Mailing address:
  • Phone: 801-636-1007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: TEESHA GONZALEZ
Title or Position: OWNER
Credential:
Phone: 801-636-1007