Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 6197043-1205 | UT |
Y | 2086S0120X | Pediatric Surgery | 6197043-1205 | UT |
NPI | 1639280480 |
---|---|
Provider Name | Dr. Jay K Riva-Cambrin |
First Address | Salt Lake City, UT 84141-3030 |
Second Address | Salt Lake City, UT 84113-1103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 26/11/2013 |