Healthcare Provider Details

I. General information

NPI: 1326733619
Provider Name (Legal Business Name): SUAESI TULIFAU DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5220 CLARK AVE STE 315
LAKEWOOD CA
90712-2635
US

IV. Provider business mailing address

5220 CLARK AVE STE 315
LAKEWOOD CA
90712-2635
US

V. Phone/Fax

Practice location:
  • Phone: 562-925-3055
  • Fax:
Mailing address:
  • Phone: 562-925-3055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE6258
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE6258
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: