Basic Information
| Provider Information | |||||||||
| NPI: | 1093968265 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORETTI | ||||||||
| FirstName: | PAOLO | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 729 S ARAPEEN DRIVE | ||||||||
| Address2: | UNIVERSITY OF UTAH | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015878123 | ||||||||
| FaxNumber: | 8015878113 | ||||||||
| Practice Location | |||||||||
| Address1: | 729 S ARAPEEN DR | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841081218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015857575 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2008 | ||||||||
| LastUpdateDate: | 11/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207SG0203X | 42482 | TX | N | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Molecular Genetics | 2084N0400X | 42482 | TX | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | 71204791205 | UT | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 199524304 | 05 | TX | MEDICAID | 147269100 | 05 | WY | MEDICAID |