Provider Demographics
NPI:1003535725
Name:LAITITI, ANETONE JR
Entity Type:Individual
Prefix:
First Name:ANETONE
Middle Name:
Last Name:LAITITI
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9045 S 1300 E STE 200
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3134
Mailing Address - Country:US
Mailing Address - Phone:801-666-6834
Mailing Address - Fax:801-904-0272
Practice Address - Street 1:9045 S 1300 E STE 200
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3134
Practice Address - Country:US
Practice Address - Phone:801-666-6834
Practice Address - Fax:801-904-0272
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker