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General NPI Number Information
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NPI Number | 1659974293
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Entity Type | Organization
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Legal Business Name | QUINTESSENCE HEALTH AND WELLNESS
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Dates
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Enumeration Date | 11/17/2020
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 12340 S 450 E
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City | DRAPER
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State | UT
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Zip | 84020-8154
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Country | US
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Telephone | 801-930-9381
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Fax | 385-275-5200
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Provider Business Mailing Address
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Address Line | 12340 S 450 E
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City | DRAPER
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State | UT
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Zip | 84020-8154
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Country | US
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Telephone | 801-930-9381
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Fax | 385-275-5200
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | ADAM LARSON
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Credential | MD
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Telephone | 801-930-9381
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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