Basic Information
| Provider Information | |||||||||
| NPI: | 1093817884 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALFARO | ||||||||
| FirstName: | ISAAC | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2561 S 1560 W STE B | ||||||||
| Address2: | |||||||||
| City: | WOODS CROSS | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840872361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015050821 | ||||||||
| FaxNumber: | 8019425955 | ||||||||
| Practice Location | |||||||||
| Address1: | 44 W BROADWAY APT 2106 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841013223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8018318141 | ||||||||
| FaxNumber: | 8663828761 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2006 | ||||||||
| LastUpdateDate: | 12/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 58988864405 | UT | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LP0808X | 5898886-4405 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 5898886-4405 | 01 | UT | LICENSE | OTHER |