Healthcare Provider Details

I. General information

NPI: 1053705665
Provider Name (Legal Business Name): ERICA SIPILI MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 3965
PAGO PAGO AS
96799-3965
US

IV. Provider business mailing address

P.O. BOX LBJ.
PAGO PAGO AS
96799
US

V. Phone/Fax

Practice location:
  • Phone: 684-633-1222
  • Fax: 684-633-2893
Mailing address:
  • Phone: 684-633-1222
  • Fax: 684-633-1896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5129A
License Number StateAS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: