OLIVIER MUTAH MULYANGOTE (NPI# 1215262944) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215262944 |
| Entity Type | Individual |
| Full Name | OLIVIER MUTAH MULYANGOTE |
| Credential | P.A. |
| Practice Address |
3195 S Main St Suite 200 Salt Lake City UT 84115-3749 |
| Practice Telephone | 8014680354 |
| Practice Fax Number | 8014680353 |
| Mailing Telephone | 8014680354 |
| Mailing Fax Number | 8014680353 |
| Enumeration Date | 2009-10-14 |
| Last Update Date | 2009-10-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 74589851206 | UT | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
3195 S MAIN ST SUITE 200 |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84115-3749 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245323039 | Donald Gary Tolboe | Dentist | 3195 S Main St, Salt Lake City, UT 84115-3749 | 2006-10-02 |
| 1588795264 | Thomas Llewellyn Jones | Legal Medicine | 3195 S Main St, Salt Lake City, UT 84115-3749 | 2007-03-07 |
| 1265548887 | Robert Smith Sumner | Dentist | 3195 S Main St, 200, Salt Lake City, UT 84115-3749 | 2006-08-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396344198 | Shannon Ballinger | Clinic/Center | 1470 400 W, Salt Lake City, UT 84115 | 2020-10-22 |
| 1992346704 | Anicka Inc | Clinic/Center | 3195 South Main St, Ste 260, South Salt Lake, UT 84115 | 2019-10-02 |
| 1083177505 | Vitor Gabriel Giuliani Alcantara Carioca | Specialist/Technologist | 1850 South Campus Drive, Salt Lake City, UT 84115 | 2019-04-11 |
| 1427528371 | Samuel James Leonhart | Behavior Technician | 354 East Coatsville Drive, Salt Lake City, UT 84115 | 2018-12-04 |
| 1093228645 | Eco Pharmacy LLC | Pharmacy | 3702 S State Street Suite 115, South Salt Lake City, UT 84115 | 2017-11-06 |
| 1568973055 | Eco Apothecary LLC | Pharmacy | 3701 S State Street Suite 114, South Salt Lake City, UT 84115 | 2017-10-24 |
| 1548780455 | Kelly Lund | Case Manager/Care Coordinator | 447 W. Bearcat Dr., Salt Lake City, UT 84115 | 2017-06-21 |
| 1104271238 | The Church of Philadelphia Inc. | Community/Behavioral Health | 2358 South Main Street, Salt Lake City, UT 84115 | 2016-04-26 |
| 1710368626 | Jennifer Swanhild Edwards | Counselor | 140 W 2100 S Ste 244, Salt Lake City, UT 84115 | 2015-06-16 |
| 1508247065 | John Mcguire | Health Educator | 1370 S. West Temple, Salt Lake City, UT 84115 | 2015-06-10 |
| Find all providers in zip 84115 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417556986 | Brittany Tran | Physician Assistant | 2733 W Redwick Ct, Salt Lake City, UT 84129-5901 | 2020-10-25 |
| 1528674975 | James Christopher Nichols | Physician Assistant | 1746 E 2100 S, Salt Lake City, UT 84106-4165 | 2020-09-21 |
| 1841826971 | David Souza | Physician Assistant | 52 N Medical Dr, Salt Lake City, UT 84132-0001 | 2020-03-20 |
| 1134751902 | Jacie Anna Mundahl | Physician Assistant | 8th Ave C St E 80, Salt Lake City, UT 84143-0001 | 2020-02-10 |
| 1336770544 | Kelsey Rae Thompson | Physician Assistant | 3809 S Parkview Dr, Salt Lake City, UT 84124-2322 | 2020-01-28 |
| 1245885458 | Adam Douglas Whitney | Physician Assistant | 1056 E Harrison Ave, Salt Lake City, UT 84105-2445 | 2019-08-05 |
| 1306498654 | Jarred J Entringer | Physician Assistant | 2725 S 700 E Apt K, Salt Lake City, UT 84106-2883 | 2019-07-16 |
| 1588216840 | Christina Thomas | Physician Assistant | 255 N 400 W Apt 5015, Salt Lake City, UT 84103-1568 | 2019-07-16 |
| 1770135022 | Evar Saelee | Physician Assistant | 2630 E Stringham Ave Apt 224a, Salt Lake City, UT 84109-3945 | 2019-07-16 |
| 1982263471 | Ashley Marten | Physician Assistant | 3610 E Cascade Way, Salt Lake City, UT 84109-2307 | 2019-06-10 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84115 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.