Healthcare Provider Details

I. General information

NPI: 1376407478
Provider Name (Legal Business Name): AMERICAN SAMOA COMMUNITY CANCER COALITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 TAFUNA ROAD AMP, STE #301
PAGO PAGO AS
96799-1716
US

IV. Provider business mailing address

PO BOX 1716
PAGO PAGO AS
96799-1716
US

V. Phone/Fax

Practice location:
  • Phone: 684-699-0110
  • Fax:
Mailing address:
  • Phone: 684-699-0110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: DR. VAATAUSILI TOFAEONO
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 684-699-0110