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General NPI Number Information
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NPI Number | 1740190511
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Entity Type | Individual
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Provider Name | VANESSA MARIE GONZALEZ CHURCHILL RD
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Gender | Female
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Dates
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Enumeration Date | 09/11/2026
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Last Update Date | 09/11/2026
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Provider Practice Location Address
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Address Line | 3828 E PINEHURST DR
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City | EAGLE MOUNTAIN
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State | UT
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Zip | 84005-6007
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Country | US
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Telephone | 801-680-6835
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Fax |
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Provider Business Mailing Address
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Address Line | 3828 E PINEHURST DR
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City | EAGLE MOUNTAIN
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State | UT
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Zip | 84005-6007
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Country | US
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Telephone | 801-680-6835
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Fax |
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 14293981-4901
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License Number State | UT
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