Healthcare Provider Details

I. General information

NPI: 1891238481
Provider Name (Legal Business Name): CUPER MARTINEZ-SANTIBANEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CUPER MARTINEZ SANTIBANEZ MD

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 S PIONEER PKWY
WEST VALLEY CITY UT
84120-2049
US

IV. Provider business mailing address

2965 W 3500 S
WEST VALLEY CITY UT
84119-3602
US

V. Phone/Fax

Practice location:
  • Phone: 801-783-5011
  • Fax: 801-746-3734
Mailing address:
  • Phone: 801-965-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number10261485-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number10261485-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: