Healthcare Provider Details

I. General information

NPI: 1073214623
Provider Name (Legal Business Name): MS. JASMINE YVETTE APARICIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3380 W 2550 S
WEST HAVEN UT
84401-9845
US

IV. Provider business mailing address

3380 W 2550 S
WEST HAVEN UT
84401-9845
US

V. Phone/Fax

Practice location:
  • Phone: 801-920-4166
  • Fax:
Mailing address:
  • Phone: 801-920-4166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12345
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: