Healthcare Provider Details

I. General information

NPI: 1922961655
Provider Name (Legal Business Name): MONA AHMED TAHA II
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2369 W ORTON CIR STE 20
WEST VALLEY CITY UT
84119-7603
US

IV. Provider business mailing address

2369 W ORTON CIR STE 20
WEST VALLEY CITY UT
84119-7603
US

V. Phone/Fax

Practice location:
  • Phone: 801-433-2299
  • Fax: 801-433-2299
Mailing address:
  • Phone: 801-433-2299
  • Fax: 801-433-2299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: