NPI 1629504642

Carissa Mora-Rodriguez

Organisation Exclusive Provider Organization Salt Lake City, UT

Practice location

Address: 415 E Woodlake Ln #152, Salt Lake City, UT 84107-1990
Phone: (801) 556-8064

Authorised official

Name: Carissa Mora-Rodriguez
Title: Owner
Phone: (801) 556-8064

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X

Other Exclusive Provider Organization providers in Utah →

Registry record

NPI: 1629504642
Entity type: Organization
NPI issued: 11 May 2017
Record last updated: 11 May 2017

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.