Provider Demographics
NPI:1710707252
Name:DROGUETI, PAULO HENRIQUE MARTINS
Entity type:Individual
Prefix:
First Name:PAULO HENRIQUE
Middle Name:MARTINS
Last Name:DROGUETI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8338 WILSON CREST WAY
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081
Mailing Address - Country:US
Mailing Address - Phone:801-918-1876
Mailing Address - Fax:
Practice Address - Street 1:8338 WILSON CREST WAY
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84081
Practice Address - Country:US
Practice Address - Phone:801-918-1876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10197706-3102163WC0200X
WAAP61655838367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine