Provider Demographics
NPI:1891427050
Name:ARVIZU, ANNALYSSA L (MSWI)
Entity type:Individual
Prefix:
First Name:ANNALYSSA
Middle Name:L
Last Name:ARVIZU
Suffix:
Gender:F
Credentials:MSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 E CLEAR BERRY CIR
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-6851
Mailing Address - Country:US
Mailing Address - Phone:801-718-5944
Mailing Address - Fax:
Practice Address - Street 1:2046 E MURRAY HOLLADAY RD STE 101
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-5173
Practice Address - Country:US
Practice Address - Phone:801-980-2566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program