| Nic | |
|
1700 N State St Suite 16 Provo UT 84604-1011 | |
| (801) 822-5644 | |
| (888) 258-9831 |
| Full Name | Nic |
|---|---|
| Speciality | Clinic/center |
| Location | 1700 N State St, Provo, Utah |
| Authorized Official Name and Position | Mariano Reginato (PRESIDENT) |
| Authorized Official Contact | 9702506170 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Nic 1700 N State St Suite 16 Provo UT 84604-1011 Ph: (801) 822-5644 | Nic 1700 N State St Suite 16 Provo UT 84604-1011 Ph: (801) 822-5644 |
| NPI Number | 1205232923 |
|---|---|
| Provider Enumeration Date | 11/06/2014 |
| Last Update Date | 11/06/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205232923 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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