Individual
TAVIA ALEASE MIMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
814 W 800 S APT C, SALT LAKE CITY, UT 84104-1491
(801) 657-2920
Mailing address
814 W 800 S APT C, SALT LAKE CITY, UT 84104-1491
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
09/02/2022
Last updated
09/02/2022
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