Individual
CRYSTAL TINA MARIE AMEZQUITA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1141 E 3900 S STE A150, SALT LAKE CITY, UT 84124-1215
(888) 949-4864
Mailing address
4460 S HIGHLAND DR, SALT LAKE CITY, UT 84124-3543
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
08/14/2018
Last updated
08/14/2018
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