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Individual

IVANNIA CASTRO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
4586 W 4410 S, WEST VALLEY CITY, UT 84120-4921
(801) 815-0817
Mailing address
4586 W 4410 S, WEST VALLEY CITY, UT 84120-4921
(801) 815-0817

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary

Other

Enumeration date
11/18/2013
Last updated
11/18/2013
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