Provider Demographics
NPI:1619486396
Name:MOLINA HEALTHCARE OF UTAH
Entity Type:Organization
Organization Name:MOLINA HEALTHCARE OF UTAH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, CLINIC INFORMATICS
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-562-5442
Mailing Address - Street 1:200 OCEANGATE STE 100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4317
Mailing Address - Country:US
Mailing Address - Phone:888-562-5442
Mailing Address - Fax:562-499-6191
Practice Address - Street 1:7050 S UNION PARK AVE STE 200
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-4171
Practice Address - Country:US
Practice Address - Phone:888-562-5442
Practice Address - Fax:562-499-6191
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOLINA HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-25
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty