Provider Demographics
NPI:1336867258
Name:POLU, ANGELA FAASALIA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:FAASALIA
Last Name:POLU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 DOLE ST APT 403
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-4835
Mailing Address - Country:US
Mailing Address - Phone:808-398-9266
Mailing Address - Fax:
Practice Address - Street 1:1329 LUSITANA ST STE 206
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2411
Practice Address - Country:US
Practice Address - Phone:808-528-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X, 363A00000X
HI1340363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant