MEDICARE: HEALING CENTER OF UTAH

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
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1154942985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING CENTER OF UTAH

Provider Business Mailing Address
First Line	:	2630 W 3500 S STE B
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-3113
Country	:	US
Telephone Number	:	801-955-8888
Fax Number	:	801-955-8889

Provider Business Practice Location Address
First Line	:	2630 W 3500 S STE B
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-3113
Country	:	US
Telephone Number	:	801-955-8888
Fax Number	:	801-955-8889

Authorized Official
Title or Position	:	OWNER
Name	:	LUIS ARTURO BECERRA
Credential	:
Telephone Number	:	801-955-8888

Provider Enumeration Date	:	05/04/2020
Last Update Date	:	05/04/2020

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Directions to “HEALING CENTER OF UTAH ” Practice Location

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