NPIMap

Organization Active NPI

Carissa Mora-Rodriguez

  • Exclusive Provider Organization
  • Salt Lake City, UT
National Provider Identifier
1629504642
Registry record updated May 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Exclusive Provider OrganizationTaxonomy code 302F00000X
Legal business name
CARISSA MORA-RODRIGUEZ
Practice address
415 E Woodlake LN
#152
Salt Lake City, UT 84107-1990
Phone
(801) 556-8064
NPI assigned
May 11, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Carissa Mora-RodriguezNPI 1154858942
Title
Owner
Phone
(801) 556-8064

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Exclusive Provider Organization 302F00000X Primary

Addresses

Primary practice location

415 E Woodlake LN
#152
Salt Lake City, UT 84107-1990

Mailing address

415 E Woodlake LN
#152
Salt Lake City, UT 84107-1990
Phone (801) 556-8064

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1494460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494460800000",
    "number": "1629504642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 E WOODLAKE LN",
            "address_2": "#152",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841071990",
            "telephone_number": "801-556-8064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 E WOODLAKE LN",
            "address_2": "#152",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841071990",
            "telephone_number": "801-556-8064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARISSA MORA-RODRIGUEZ",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-11",
        "last_updated": "2017-05-11",
        "status": "A",
        "authorized_official_last_name": "MORA-RODRIGUEZ",
        "authorized_official_first_name": "CARISSA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-556-8064"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.