Individual
MAITE ANTOLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
421 N OREM BLVD, OREM, UT 84057-8813
(801) 764-0200
(801) 764-0206
Mailing address
421 N OREM BLVD, OREM, UT 84057-8813
(801) 764-0200
(801) 764-0206
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
11971127-1206
UT
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
07/05/2020
Last updated
10/13/2021
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