Healthcare Provider Details

I. General information

NPI: 1053227934
Provider Name (Legal Business Name): ROSANNA GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9221 S REDWOOD RD STE B
WEST JORDAN UT
84088-5803
US

IV. Provider business mailing address

9221 S REDWOOD RD STE B
WEST JORDAN UT
84088-5803
US

V. Phone/Fax

Practice location:
  • Phone: 801-814-4046
  • Fax: 385-325-2226
Mailing address:
  • Phone: 801-814-4046
  • Fax: 385-325-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number142688784701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: