Healthcare Provider Details

I. General information

NPI: 1386227973
Provider Name (Legal Business Name): ONITA VELMA FANGU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ONITA VELMA KAUFUSI

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 04/30/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W 1900 S
BOUNTIFUL UT
84010-5530
US

IV. Provider business mailing address

105 W 1900 S
BOUNTIFUL UT
84010-5530
US

V. Phone/Fax

Practice location:
  • Phone: 385-777-6587
  • Fax:
Mailing address:
  • Phone: 385-777-6587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberZ4J5H6Z8
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: