Healthcare Provider Details

I. General information

NPI: 1356128680
Provider Name (Legal Business Name): WINIFREDO SALAZAR TIANGCO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/11/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11155 TURNER DRIVE
PAGO PAGO AS
96799
US

IV. Provider business mailing address

PO BOX LBJ
PAGO PAGO AS
96799-0010
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number5080C
License Number StateAS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: