Provider Demographics
NPI:1326747148
Name:MATH, SANILA
Entity Type:Individual
Prefix:
First Name:SANILA
Middle Name:
Last Name:MATH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9864 S CONGRESSIONAL WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-3387
Mailing Address - Country:US
Mailing Address - Phone:408-807-2951
Mailing Address - Fax:
Practice Address - Street 1:9864 S CONGRESSIONAL WAY
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-3387
Practice Address - Country:US
Practice Address - Phone:408-807-2951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000OtherNO OTHER PROVIER IDENTIFIERS