MEDICARE: DENISE MARTINEZ GASCOIGNE MS, RD, CN

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	133V00000X	Registered Dietitian	6424526-4901	UT

General Provider Information

NPI Number	:	1427522077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE MARTINEZ GASCOIGNE MS, RD, CN

Provider Business Mailing Address
First Line	:	3423 E ANTLER WAY
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-4405
Country	:	US
Telephone Number	:	508-505-0015
Fax Number	:	508-448-0404

Provider Business Practice Location Address
First Line	:	3423 E ANTLER WAY
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-4405
Country	:	US
Telephone Number	:	508-505-0015
Fax Number	:	508-448-0404

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2019
Last Update Date	:	11/29/2021

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