Organization
CONFEDERATED TRIBES OF THE GOSHUTE RESERVATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL CONTRERAS (BILLING)
(801) 359-2256
Entity
Organization
Contact information
Practice address
195 TRIBAL CENTER RD, IBAPAH, UT 84034
(435) 234-1194
(435) 234-1202
Mailing address
660 S 200 E STE 250, SALT LAKE CITY, UT 84111-3846
(801) 359-2256
(801) 364-4392
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
07/06/2009
Last updated
02/05/2020
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