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General NPI Number Information
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NPI Number | 1063448371
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Entity Type | Individual
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Provider Name | ILYSSA GOLDING MD
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Gender | Female
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 01/17/2013
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Provider Practice Location Address
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Address Line | 1200 E 3900 S
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City | SALT LAKE CITY
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State | UT
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Zip | 84124-1300
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Country | US
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Telephone | 801-268-7111
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Fax | 801-296-6199
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Provider Business Mailing Address
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Address Line | 380 N 200 W SUITE 209
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City | BOUNTIFUL
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State | UT
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Zip | 84010-7079
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Country | US
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Telephone | 801-298-1300
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Fax | 801-296-6199
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | G78242
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 8295697-1205
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License Number State | UT
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