Provider Demographics
NPI:1487326195
Name:CLINICA MI SALUD LLC
Entity type:Organization
Organization Name:CLINICA MI SALUD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ISRAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALARCON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-897-9939
Mailing Address - Street 1:2470 S REDWOOD RD STE 208
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-2197
Mailing Address - Country:US
Mailing Address - Phone:801-214-0500
Mailing Address - Fax:801-214-0600
Practice Address - Street 1:2470 S REDWOOD RD STE 208
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-2197
Practice Address - Country:US
Practice Address - Phone:801-214-0500
Practice Address - Fax:801-214-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center