Healthcare Provider Details

I. General information

NPI: 1326323916
Provider Name (Legal Business Name): STARR MAIUU FUIMAONO BA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2011
Last Update Date: 10/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3481 E SUNSET RD STE 100
LAS VEGAS NV
89120-6207
US

IV. Provider business mailing address

3135 S. MOHAVE RD.
LAS VEGAS NV
89121
US

V. Phone/Fax

Practice location:
  • Phone: 702-998-6264
  • Fax:
Mailing address:
  • Phone: 619-817-1124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberE1616395
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: