Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 5704600-1205 | UT |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 5704600-1205 | UT |
NPI | 1083788178 |
---|---|
Provider Name | Dr. Mariana Claudia Baserga |
First Address | Salt Lake City, UT 84158-1100 |
Second Address | Salt Lake City, UT 84113-1103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 21/10/2021 |