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NPI Code Detail

MEDICARE: SHANTALL CARRASCO GONZALEZ

MEDICARE: SHANTALL CARRASCO GONZALEZ
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
1106S00000XBehavior TechnicianRBT-26-520896UT

General Provider Information

NPI Number : 1629925441
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANTALL CARRASCO GONZALEZ
Provider Business Mailing Address
First Line : 3737 W 4100 S
Second Line :
City : WEST VALLEY CITY
State : UT
Zip : 84120-5543
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 780 S GUARDSMAN WAY
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84108-1374
Country : US
Telephone Number : 888-949-4864
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2026
Last Update Date : 03/11/2026

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Directions to “ SHANTALL CARRASCO GONZALEZ ” Practice Location

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