Provider Demographics
NPI:1295913895
Name:NASERI, TAKE KOLISI
Entity type:Individual
Prefix:DR
First Name:TAKE
Middle Name:KOLISI
Last Name:NASERI
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 1:4553 NUUULI RD.
Mailing Address - Street 2:
Mailing Address - City:PAGO PAGO
Mailing Address - State:AS
Mailing Address - Zip Code:96799-4553
Mailing Address - Country:US
Mailing Address - Phone:684-699-5118
Mailing Address - Fax:684-699-5336
Practice Address - Street 1:4553 NUUULI RD.
Practice Address - Street 2:
Practice Address - City:PAGO PAGO
Practice Address - State:AS
Practice Address - Zip Code:96799-4553
Practice Address - Country:US
Practice Address - Phone:684-699-5118
Practice Address - Fax:684-699-5336
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AS2028-C282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital