Individual
SUSANNA IVETTE MAYORGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCM
Contact information
Practice address
151 S UNIVERSITY AVE STE 1400, PROVO, UT 84601-4427
(801) 851-7118
Mailing address
138 S 1100 W, SPRINGVILLE, UT 84663-5507
(801) 369-7538
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/14/2021
Last updated
09/14/2021
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