Most Relevant Information
Provider Data
| NPI Number: | 1003490046 |
| Provider Name: | ANDRES GERARDO RIVERA |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/06/2021 |
| Last Updated: | 05/06/2021 |
Provider Practice Location
375 S CHIPETA WAY STE A
SALT LAKE CITY
UT
841081261
Practice Location Phone/Fax
| Phone: | 8015817766 |
| Fax: |
Provider Mailing Location
375 S CHIPETA WAY STE A
SALT LAKE CITY
UT
841081261
Provider Mailing Phone/Fax
| Phone: | 8015817766 |
| Fax: |