Provider Demographics
NPI:1558124941
Name:VAITAI, SILIA TUPOU
Entity Type:Individual
Prefix:
First Name:SILIA
Middle Name:TUPOU
Last Name:VAITAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 W 600 S UNIT 250
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-2784
Mailing Address - Country:US
Mailing Address - Phone:385-371-8469
Mailing Address - Fax:
Practice Address - Street 1:154 W 600 S UNIT 250
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-2784
Practice Address - Country:US
Practice Address - Phone:385-371-8469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTLIC2023-01022253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care