Healthcare Provider Details

I. General information

NPI: 1811938871
Provider Name (Legal Business Name): ANNIE J FUAVAI MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LBJ TROPICAL MEDICAL CENTER
PAGO PAGO AMERICAN SAMOA
96799
UM

IV. Provider business mailing address

P.O.BOX 95
PAGO PAGO AMERICAN SAMOA
96799
UM

V. Phone/Fax

Practice location:
  • Phone: 684-258-5038
  • Fax:
Mailing address:
  • Phone: 684-258-5038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2025A
License Number StateAS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: