1841255627 NPI number — MR. HEMALOTO KATOA L.C.S.W.

Table of content: MR. HEMALOTO KATOA L.C.S.W. (NPI 1841255627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841255627 NPI number — MR. HEMALOTO KATOA L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KATOA
Provider First Name:
HEMALOTO
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841255627
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1740 N 2230 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEHI
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84043-3218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-768-0244
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9176 S 300 W
Provider Second Line Business Practice Location Address:
SUITE 34
Provider Business Practice Location Address City Name:
SANDY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84070-2668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-403-4025
Provider Business Practice Location Address Fax Number:
801-601-3195
Provider Enumeration Date:
04/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  5655802-3501 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 788007788049 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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