Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 5384724-1205 | UT |
NPI | 1366640864 |
---|---|
Provider Name | Denise Morita |
First Address | Riverton, UT 84065-6794 |
Second Address | Riverton, UT 84065-6794 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2007 |
Last Update Date | 27/03/2018 |