Provider Demographics
NPI:1205034113
Name:PIACITELLI, ANNLIZA LACHICA (MD)
Entity Type:Individual
Prefix:
First Name:ANNLIZA
Middle Name:LACHICA
Last Name:PIACITELLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1868 W 9800 S
Mailing Address - Street 2:STE 100
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-4713
Mailing Address - Country:US
Mailing Address - Phone:801-433-2873
Mailing Address - Fax:
Practice Address - Street 1:1868 W 9800 S
Practice Address - Street 2:STE 100
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-4713
Practice Address - Country:US
Practice Address - Phone:801-433-2873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT77348801205207Q00000X
UT773-4880-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine