Provider Demographics
NPI:1538702709
Name:413 OGDEN, INC
Entity Type:Organization
Organization Name:413 OGDEN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ-FERRATE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-651-4283
Mailing Address - Street 1:PO BOX 971532
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-1532
Mailing Address - Country:US
Mailing Address - Phone:801-691-1264
Mailing Address - Fax:888-972-4917
Practice Address - Street 1:413 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404-6320
Practice Address - Country:US
Practice Address - Phone:385-238-4123
Practice Address - Fax:385-238-4166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty