Provider Demographics
NPI:1609144658
Name:FAUATEA, JARED FALETOI
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:FALETOI
Last Name:FAUATEA
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 1:9129 W. DESERT INN RD. APT 108
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-6332
Mailing Address - Country:US
Mailing Address - Phone:702-834-5508
Mailing Address - Fax:
Practice Address - Street 1:9129 W DESERT INN RD APT 108
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-6332
Practice Address - Country:US
Practice Address - Phone:702-834-5508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner