Provider Demographics
NPI:1881405454
Name:PASIKALA, DEEJAY
Entity type:Individual
Prefix:
First Name:DEEJAY
Middle Name:
Last Name:PASIKALA
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 1:9447 N ARROWHEAD DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-3105
Mailing Address - Country:US
Mailing Address - Phone:808-384-9223
Mailing Address - Fax:
Practice Address - Street 1:9447 N ARROWHEAD DR
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-3105
Practice Address - Country:US
Practice Address - Phone:808-384-9223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1744G0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744G0900XOther Service ProvidersSpecialistGraphics Designer