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General NPI Number Information
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NPI Number | 1770323214
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Entity Type | Organization
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Legal Business Name | RED ROCK C & C DRIP SPA LLC
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Dates
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Enumeration Date | 05/31/2024
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 3687 PIONEER PARKWAY #1
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City | SANTA CLARA
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State | UT
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Zip | 84765
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Country | US
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Telephone | 435-922-3747
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Fax |
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Provider Business Mailing Address
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Address Line | 3687 PIONEER PARKWAY #1
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City | SANTA CLARA
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State | UT
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Zip | 84765
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Country | US
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Telephone | 435-922-3747
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CAROLYN MARTIN
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Credential |
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Telephone | 435-922-3747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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