Provider Demographics
NPI:1578807798
Name:MANUA HEALTH SYSTEM, INC
Entity Type:Organization
Organization Name:MANUA HEALTH SYSTEM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER/CMO
Authorized Official - Prefix:DR
Authorized Official - First Name:MALOUAMAUA
Authorized Official - Middle Name:PULEISILI
Authorized Official - Last Name:TUIOLOSEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD,MB,BS,PCP
Authorized Official - Phone:684-770-9264
Mailing Address - Street 1:41-1300 WAIKUPANAHA ST
Mailing Address - Street 2:
Mailing Address - City:WAIMANALO
Mailing Address - State:HI
Mailing Address - Zip Code:96795
Mailing Address - Country:US
Mailing Address - Phone:808-259-6309
Mailing Address - Fax:808-440-5606
Practice Address - Street 1:102 LUMA TAI RD, TA'U VILLAGE
Practice Address - Street 2:
Practice Address - City:MANU'A ISLAND
Practice Address - State:AS
Practice Address - Zip Code:96799
Practice Address - Country:US
Practice Address - Phone:684-677-3513
Practice Address - Fax:684-677-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AS3140170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Multi-Specialty