Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | 110430-2501 | UT |
NPI | 1154574127 |
---|---|
Provider Name | Dr. Noemi Perelman Mattis |
First Address | Salt Lake City, UT 84103-4491 |
Second Address | Salt Lake City, UT 84103-4491 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2008 |
Last Update Date | 04/11/2008 |