Individual
ILAVALU MAPA VAENUKU II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3280 W 3500 S STE E, WEST VALLEY CITY, UT 84119-2668
(385) 347-5208
Mailing address
3280 W 3500 S STE E, WEST VALLEY CITY, UT 84119-2668
(385) 347-5208
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
UT
Other
Enumeration date
08/05/2020
Last updated
08/05/2020
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