=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336217793
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAVIER NORIEGA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1380 E MEDICAL CENTER DR # 109
-----------------------------------------------------
City | ST GEORGE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84790-2123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-649-8810
-----------------------------------------------------
Fax | 801-516-1418
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1380 E MEDICAL CENTER DR # 109
-----------------------------------------------------
City | ST GEORGE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84790-2123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-649-8810
-----------------------------------------------------
Fax | 801-516-1418
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JAVIER NORIEGA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 801-649-8810
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------