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General NPI Number Information
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NPI Number | 1407029275
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Entity Type | Organization
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Legal Business Name | STONEBROOK MEDICAL L.L.C
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Dates
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Enumeration Date | 04/11/2008
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Last Update Date | 04/11/2008
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Provider Practice Location Address
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Address Line | 36 N 1100 E SUITE D
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City | AMERICAN FORK
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State | UT
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Zip | 84003-2918
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Country | US
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Telephone | 801-763-7803
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Fax | 801-763-7810
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Provider Business Mailing Address
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Address Line | 36 N 1100 E SUITE D
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City | AMERICAN FORK
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State | UT
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Zip | 84003-2918
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Country | US
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Telephone | 801-763-7803
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Fax | 801-763-7810
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | MYRNA L LOVELESS
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Credential |
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Telephone | 801-763-7803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 4591
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License Number State | UT
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