Healthcare Provider Details

I. General information

NPI: 1083100259
Provider Name (Legal Business Name): TEANCUM TUPUIMATAGI FAUMUI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W 520 N
OREM UT
84057-4696
US

IV. Provider business mailing address

PO BOX 51078
PROVO UT
84605-1078
US

V. Phone/Fax

Practice location:
  • Phone: 435-851-5296
  • Fax:
Mailing address:
  • Phone: 435-851-5296
  • Fax: 801-373-0639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: