Provider Demographics
NPI:1437711165
Name:MISRASI, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MISRASI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8137 S COTTONWOOD HILLS CIR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-0860
Mailing Address - Country:US
Mailing Address - Phone:801-913-6464
Mailing Address - Fax:801-797-1220
Practice Address - Street 1:494 W 1400 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-7001
Practice Address - Country:US
Practice Address - Phone:801-913-6464
Practice Address - Fax:801-797-1220
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker