Organization
SANTIBANEZ PAC UTAH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE ROSER (VP OF OPERATIONS)
(775) 222-0045
Entity
Organization
Contact information
Practice address
451 E BISHOP FEDERAL LN, SALT LAKE CITY, UT 84115-2357
(801) 487-7557
Mailing address
10775 DOUBLE R BLVD, RENO, NV 89521-8956
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
11/24/2023
Last updated
11/24/2023
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