Provider Demographics
NPI:1578003000
Name:SOIFUA, PENIAMINA
Entity Type:Individual
Prefix:
First Name:PENIAMINA
Middle Name:
Last Name:SOIFUA
Suffix:
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 1:195 E 840 S
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-5016
Mailing Address - Country:US
Mailing Address - Phone:801-226-7696
Mailing Address - Fax:801-225-7053
Practice Address - Street 1:195 E 840 S
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-5016
Practice Address - Country:US
Practice Address - Phone:801-226-7696
Practice Address - Fax:801-225-7053
Is Sole Proprietor?:No
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker