Provider Demographics
NPI:1750010021
Name:TONGA, ILAISAANE MINIONETI
Entity Type:Individual
Prefix:
First Name:ILAISAANE
Middle Name:MINIONETI
Last Name:TONGA
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 1:526 COZY DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-4810
Mailing Address - Country:US
Mailing Address - Phone:408-606-0860
Mailing Address - Fax:
Practice Address - Street 1:208 CALDWELL AVE
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-5401
Practice Address - Country:US
Practice Address - Phone:408-606-0860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider