Healthcare Provider Details

I. General information

NPI: 1598079949
Provider Name (Legal Business Name): JILL ZUNIGA APC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8097 JACKSON LAKE DR
WEST JORDAN UT
84081-5577
US

IV. Provider business mailing address

8097 JACKSON LAKE DR
WEST JORDAN UT
84081-5577
US

V. Phone/Fax

Practice location:
  • Phone: 801-280-3200
  • Fax:
Mailing address:
  • Phone: 801-280-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7756290-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: