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NPI Code Detail

MEDICARE: DESTANI AMANDA ORTIZ

MEDICARE: DESTANI AMANDA ORTIZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225800000XRecreation Therapist1392825-4003UT

General Provider Information

NPI Number : 1104665421
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESTANI AMANDA ORTIZ
Provider Business Mailing Address
First Line : 3588 S 4200 W APT A3
Second Line :
City : WEST VALLEY CITY
State : UT
Zip : 84120-3272
Country : US
Telephone Number : 801-971-9278
Fax Number :
Provider Business Practice Location Address
First Line : 50 E 9000 S
Second Line :
City : SANDY
State : UT
Zip : 84070-2201
Country : US
Telephone Number : 801-561-9839
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2024
Last Update Date : 05/24/2024

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Directions to “ DESTANI AMANDA ORTIZ ” Practice Location

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