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General NPI Number Information
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NPI Number | 1164286761
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Entity Type | Organization
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Legal Business Name | VIRTARE HEALTH PHYSICIAN SERVICES OF UTAH PLLC
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Dates
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Enumeration Date | 02/13/2024
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 1100 E 6600 S SUITE 180
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City | SALT LAKE CITY
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State | UT
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Zip | 84121
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Country | US
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Telephone | 855-745-8400
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Fax |
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Provider Business Mailing Address
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Address Line | 10890 THORNMINT RD
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City | SAN DIEGO
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State | CA
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Zip | 92127-2402
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Country | US
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Telephone | 855-734-8400
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | FRANKLIN MOSES
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Credential | MBBS
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Telephone | 855-745-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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