Healthcare Provider Details

I. General information

NPI: 1457205015
Provider Name (Legal Business Name): DANIEL MARTY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 W 9000 S
WEST JORDAN UT
84088-8812
US

IV. Provider business mailing address

1900 W 3255 S
WEST VALLEY UT
84119-3243
US

V. Phone/Fax

Practice location:
  • Phone: 801-568-3480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: