Provider Demographics
NPI:1790264216
Name:OPIYO, BENTA
Entity Type:Individual
Prefix:
First Name:BENTA
Middle Name:
Last Name:OPIYO
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 1:208 E FLICKER DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-1637
Mailing Address - Country:US
Mailing Address - Phone:801-935-7006
Mailing Address - Fax:
Practice Address - Street 1:208 E FLICKER DR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-1637
Practice Address - Country:US
Practice Address - Phone:801-935-7006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator