Individual
OLIVIER MUTAH MULYANGOTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
3195 S MAIN ST, SUITE 200, SALT LAKE CITY, UT 84115-3749
(801) 468-0354
(801) 468-0353
Mailing address
3195 S MAIN ST, SUITE 200, SALT LAKE CITY, UT 84115-3749
(801) 468-0354
(801) 468-0353
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
74589851206
UT
Other
Enumeration date
10/14/2009
Last updated
05/02/2023
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