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Organization
SCOPE
Active
Organization
SCOPE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARCE LATSIS (DIRECTOR OF CLIENT SERVICES)
(801) 441-1002
Entity
Organization
Contact information
Practice address
10000 S CENTENNIAL PKWY, SANDY, UT 84070-4148
(801) 568-4665
Mailing address
560 S 300 E STE 275, SALT LAKE CITY, UT 84111-3586
(801) 441-1002
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
70619161204
UT
Other
Enumeration date
02/20/2015
Last updated
01/30/2020
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