Provider Demographics
NPI:1689426363
Name:VUKUNISIGA, KITIONE BALAWA
Entity Type:Individual
Prefix:
First Name:KITIONE
Middle Name:BALAWA
Last Name:VUKUNISIGA
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:PO BOX 500409
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950-0409
Mailing Address - Country:US
Mailing Address - Phone:670-234-8950
Mailing Address - Fax:
Practice Address - Street 1:ROTA HEALTH CENTRE
Practice Address - Street 2:
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96951
Practice Address - Country:US
Practice Address - Phone:670-532-9461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MP024125J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125J00000XDental ProvidersDental Therapist