Evergreen Clinic LLC
NPI #1689210551 in West Jordan, Utah
Provider Information
- NPI Number
- 1689210551
- Entity Type
- Organization
- Organization Name
- Evergreen Clinic LLC
- Primary Specialty
- Family Medicine
- Enumeration Date
- Nov 25, 2019
- Last Updated
- Jan 13, 2020
Practice Location
- Address
- 1561 W 7000 S STE 100
- City
- West Jordan
- State
- Utah
- ZIP Code
- 84084-3556
- Phone
- (801) 850-1958
Authorized Official
- Name
- IGNACIO NICOLAS GONZALEZ
- Title
- ADMINISTRATOR
- Phone
- (801) 850-1958
Specialties & Taxonomy Codes
| Specialty |
|---|
| Family Medicine |
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