Provider Demographics
NPI:1740514892
Name:IBARRA-TAYLOR, DANIEL (PA)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:IBARRA-TAYLOR
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3723 W 12600 S STE 270
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-7296
Mailing Address - Country:US
Mailing Address - Phone:801-285-4622
Mailing Address - Fax:801-285-4601
Practice Address - Street 1:3723 W 12600 S STE 270
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7296
Practice Address - Country:US
Practice Address - Phone:801-285-4622
Practice Address - Fax:801-285-4601
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT74247635-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant