Provider Demographics
NPI:1326748633
Name:HAVILI, VILCA FAUIKI (PA STUDENT)
Entity Type:Individual
Prefix:
First Name:VILCA
Middle Name:FAUIKI
Last Name:HAVILI
Suffix:
Gender:F
Credentials:PA STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 W THACKIE CIR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84104-2937
Mailing Address - Country:US
Mailing Address - Phone:702-410-3585
Mailing Address - Fax:
Practice Address - Street 1:1322 W THACKIE CIR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84104-2937
Practice Address - Country:US
Practice Address - Phone:702-410-3585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program