Organization
CARISSA MORA-RODRIGUEZ
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARISSA MORA-RODRIGUEZ (OWNER)
(801) 556-8064
Entity
Organization
Contact information
Practice address
415 E WOODLAKE LN, #152, SALT LAKE CITY, UT 84107-1990
(801) 556-8064
Mailing address
415 E WOODLAKE LN, #152, SALT LAKE CITY, UT 84107-1990
(801) 556-8064
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
—
Other
Enumeration date
05/11/2017
Last updated
05/11/2017
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