Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 7887891 | UT |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 7887891-1205 | UT |
NPI | 1013237593 |
---|---|
Provider Name | Amy Noel De La Garza |
First Address | Salt Lake City, UT 84102-1358 |
Second Address | Salt Lake City, UT 84102-1358 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2010 |
Last Update Date | 17/12/2021 |