Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 5269990-1205 | UT |
NPI | 1033175765 |
---|---|
Provider Name | Luciana De Saibro |
First Address | Salt Lake City, UT 84127-0128 |
Second Address | St George, UT 84790 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 16/09/2021 |