# MA BO INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MA BO INC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1588185581
- **Legal business name:** MA BO INC
- **Authorized official:** CAITLIN DANIELLE CACCIATORE (OFFICE MANAGER)
- **Authorized official phone:** (801) 485-5055

## Contact information

- **Practice address:** 466 E 500 S STE 200, SALT LAKE CITY, UT 84111-3350
- **Practice address phone:** (801) 485-5055
- **Practice address fax:** (801) 467-3296
- **Mailing address:** 466 E 500 S STE 200, SALT LAKE CITY, UT 84111-3350
- **Mailing address phone:** (801) 485-5055
- **Mailing address fax:** (801) 467-3296

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/29/2017
- **Last updated:** 07/19/2024