Most Relevant Information
Provider Data
| NPI Number: | 1003256967 |
| Provider Name: | JESSE JUDD-DOMINGUEZ |
| Entity Type: | Individual |
| Taxonomy Code: | 172V00000X |
| Specialty: | Community Health Worker |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/25/2013 |
| Last Updated: | 06/25/2013 |
Provider Practice Location
1344 W STATE RD
PLEASANT GROVE
UT
840625022
Practice Location Phone/Fax
| Phone: | 8017858870 |
| Fax: |
Provider Mailing Location
1344 W STATE RD
PLEASANT GROVE
UT
840625022
Provider Mailing Phone/Fax
| Phone: | 8017858870 |
| Fax: |