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General NPI Number Information
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NPI Number | 1851288856
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Entity Type | Organization
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Legal Business Name | PINE VALLEY HEALTH UTAH LLC
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Dates
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Enumeration Date | 06/23/2025
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 3507 N UNIVERSITY AVE STE 100
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City | PROVO
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State | UT
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Zip | 84604-4479
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Country | US
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Telephone | 208-247-5050
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Fax |
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Provider Business Mailing Address
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Address Line | 3507 N UNIVERSITY AVE STE 100
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City | PROVO
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State | UT
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Zip | 84604-4479
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Country | US
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Telephone | 208-247-5050
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | ARSHABH SARDA
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Credential |
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Telephone | 208-247-5050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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