Individual
MR. IAN DANIEL PRIMAVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
75 N 2260 W, HURRICANE, UT 84737-2034
(760) 757-0224
Mailing address
75 N 2260 W, HURRICANE, UT 84737-2034
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
12870631-1206
UT
363AM0700X
Medical Physician Assistant
PA22615
CA
Other
Enumeration date
10/09/2012
Last updated
07/25/2022
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