Individual
MRS. MARTHA P MANDUJANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4745 S 3200 W, SALT LAKE CITY, UT 84118-2822
(801) 964-6214
(801) 982-9232
Mailing address
3536 S 1100 E, SALT LAKE CITY, UT 84106-2451
(801) 347-3520
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
6028041-1206
UT
Other
Enumeration date
09/14/2006
Last updated
11/20/2021
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