Organization
MA BO INC
Active
Parent organization
MA BO INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MA BO INC
Authorized official
CAITLIN DANIELLE CACCIATORE (OFFICE ADMINISTRATOR)
(801) 485-5055
Entity
Organization
Contact information
Practice address
522 E 100 S, SALT LAKE CITY, UT 84102-1905
(801) 485-5055
(801) 467-3296
Mailing address
522 E 100 S, SALT LAKE CITY, UT 84102-1905
(801) 485-5055
(801) 467-3296
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
09/10/2019
Last updated
09/10/2019
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