Organization
CANYON CREST SURGICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICKIE K GLAUSER (OFFICE STAFF)
(801) 316-1313
Entity
Organization
Contact information
Practice address
11762 S STATE #240, DRAPER, UT 84020
(801) 542-7194
(801) 542-7193
Mailing address
11762 S STATE #240, DRAPER, UT 84020
(801) 542-7194
(801) 542-7193
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
2008-ASF-86531
UT
Other
Enumeration date
12/08/2008
Last updated
12/08/2008
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