MEDICARE: KATHERINE ROGOMENTICH RD

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	86329564

General Provider Information

NPI Number	:	1922870823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE ROGOMENTICH RD

Provider Business Mailing Address
First Line	:	2282 S 1800 E APT A
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-4163
Country	:	US
Telephone Number	:	978-604-8773
Fax Number	:

Provider Business Practice Location Address
First Line	:	2282 S 1800 E APT A
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-4163
Country	:	US
Telephone Number	:	978-604-8773
Fax Number	:

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

Provider Enumeration Date	:	10/24/2023
Last Update Date	:	10/24/2023

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Directions to “ KATHERINE ROGOMENTICH RD” Practice Location

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