Healthcare Provider Details

I. General information

NPI: 1629610027
Provider Name (Legal Business Name): PATRICIA ESPARZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 W 4100 S
WEST VALLEY CITY UT
84128-4338
US

IV. Provider business mailing address

4427 S LAGO GRANDE DR
WEST VALLEY CITY UT
84128-5632
US

V. Phone/Fax

Practice location:
  • Phone: 801-966-6546
  • Fax:
Mailing address:
  • Phone: 801-671-3170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7147574-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: