Healthcare Provider Details

I. General information

NPI: 1790322311
Provider Name (Legal Business Name): AMIRA LATORRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 W 3500 S STE E
WEST VALLEY CITY UT
84119-2668
US

IV. Provider business mailing address

3280 W 3500 S STE E
WEST VALLEY CITY UT
84119-2668
US

V. Phone/Fax

Practice location:
  • Phone: 801-979-1351
  • Fax: 801-905-1161
Mailing address:
  • Phone: 801-979-1351
  • Fax: 801-905-1161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6153258-3502
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: