Basic Information
| Provider Information | |||||||||
| NPI: | 1760542054 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZENDEJAS RUIZ | ||||||||
| FirstName: | IVAN | ||||||||
| MiddleName: | RODRIGO | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5171 S COTTONWOOD ST | ||||||||
| Address2: | STE 650 | ||||||||
| City: | MURRAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841075716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522650606 | ||||||||
| FaxNumber: | 3522650678 | ||||||||
| Practice Location | |||||||||
| Address1: | 5171 S COTTONWOOD ST | ||||||||
| Address2: | STE 650 | ||||||||
| City: | MURRAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841075716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522650606 | ||||||||
| FaxNumber: | 3522650678 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2006 | ||||||||
| LastUpdateDate: | 06/29/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204F00000X | 10757 | FL | N | Allopathic & Osteopathic Physicians | Transplant Surgery | 208600000X | ME108537 | FL | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 9580790-1205 | UT | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.