Healthcare Provider Details

I. General information

NPI: 1871150516
Provider Name (Legal Business Name): PATRICIA AGUAYO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7625 S 3200 W STE 2
WEST JORDAN UT
84084-2887
US

IV. Provider business mailing address

201 N 2830 W
PROVO UT
84601-2143
US

V. Phone/Fax

Practice location:
  • Phone: 801-915-0359
  • Fax:
Mailing address:
  • Phone: 801-380-2142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: