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General NPI Number Information
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NPI Number | 1457768160
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Entity Type | Individual
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Provider Name | VILIAMI HAANGANA VAKAUTAKAKALA DPM
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Gender | Male
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Dates
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Enumeration Date | 07/14/2014
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Last Update Date | 06/14/2017
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Provider Practice Location Address
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Address Line | 880 N MAIN ST
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City | RICHFIELD
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State | UT
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Zip | 84701-4218
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Country | US
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Telephone | 435-896-0668
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Fax |
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Provider Business Mailing Address
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Address Line | 620 N 700 E
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City | RICHFIELD
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State | UT
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Zip | 84701-1941
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 102563980501
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License Number State | UT
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