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General NPI Number Information
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NPI Number | 1740514892
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Entity Type | Individual
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Provider Name | DANIEL IBARRA-TAYLOR PA
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Gender | Male
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Dates
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Enumeration Date | 09/22/2009
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 3723 W 12600 S STE 270
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City | RIVERTON
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State | UT
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Zip | 84065-7296
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Country | US
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Telephone | 801-285-4622
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Fax | 801-285-4601
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Provider Business Mailing Address
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Address Line | 3723 W 12600 S STE 270
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City | RIVERTON
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State | UT
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Zip | 84065-7296
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Country | US
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Telephone | 801-285-4622
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Fax | 801-285-4601
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 74247635-1206
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License Number State | UT
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