Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Carissa Mora-Rodriguez

Organization Exclusive Provider Organization · NPI 1629504642

Carissa Mora-Rodriguez is an Exclusive Provider Organization in Salt Lake City, Utah. Registered with an NPI since 2017.

In the registry since
2017

Practice location Address checks out

415 E Woodlake Ln #152
Salt Lake City, UT 84107-1990
Phone: (801) 556-8064
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Exclusive Provider Organization (primary) Taxonomy 302F00000X

Record details

NPI number1629504642
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Carissa Mora-Rodriguez — Owner · (801) 556-8064
NPI enumeratedMay 11, 2017
Last updated in NPPESMay 11, 2017
Mailing address415 E Woodlake Ln, 152, Salt Lake City, UT 84107-1990

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