Provider Demographics
NPI:1316117344
Name:AVENUES TO HEALTH, LLC
Entity type:Organization
Organization Name:AVENUES TO HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSANA
Authorized Official - Middle Name:KINIKINI
Authorized Official - Last Name:MOUNGA
Authorized Official - Suffix:
Authorized Official - Credentials:C-FNP
Authorized Official - Phone:801-521-2220
Mailing Address - Street 1:223 W 700 S
Mailing Address - Street 2:SUITE D
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-2718
Mailing Address - Country:US
Mailing Address - Phone:801-521-2220
Mailing Address - Fax:801-521-2221
Practice Address - Street 1:223 W 700 S
Practice Address - Street 2:SUITE D
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-2718
Practice Address - Country:US
Practice Address - Phone:801-521-2220
Practice Address - Fax:801-521-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT20071866261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care