Healthcare Provider Details

I. General information

NPI: 1467842559
Provider Name (Legal Business Name): ELIA KARETI TITIIMAEA MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2015
Last Update Date: 01/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FIRST ST. FAGAALU
PAGO PAGO AS
96799
US

IV. Provider business mailing address

FIRST STREET FAGAALU
PAGO PAGO AS
96799
US

V. Phone/Fax

Practice location:
  • Phone: 684-699-6380
  • Fax: 685-699-6374
Mailing address:
  • Phone: 684-699-6380
  • Fax: 685-699-6374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2212-A
License Number StateAS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: