Healthcare Provider Details

I. General information

NPI: 1801273420
Provider Name (Legal Business Name): OFFICE OF SAMOAN AFFAIRS OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2015
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998399 OTTOVILLE TAFUNA
PAGO PAGO AMERICAN SAMOA
96799
UM

IV. Provider business mailing address

20715 AVALON BLVD STE 200
CARSON CA
90746-3319
US

V. Phone/Fax

Practice location:
  • Phone: 684-699-8091
  • Fax:
Mailing address:
  • Phone: 310-538-0555
  • Fax: 310-538-1960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. JUNE V POUESI
Title or Position: EXECUTIVE DIRECTOR
Credential: M.A.
Phone: 310-538-0555