Provider Demographics
NPI:1770790768
Name:ANESI, ALOIAMOA (MBCHB)
Entity type:Individual
Prefix:
First Name:ALOIAMOA
Middle Name:
Last Name:ANESI
Suffix:
Gender:M
Credentials:MBCHB
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 LBJTMC
Mailing Address - Street 2:
Mailing Address - City:PAGO PAGO
Mailing Address - State:AS
Mailing Address - Zip Code:96799
Mailing Address - Country:US
Mailing Address - Phone:684-633-1683
Mailing Address - Fax:684-633-5107
Practice Address - Street 1:96796 TURNER DRIVE
Practice Address - Street 2:
Practice Address - City:PAGO PAGO
Practice Address - State:AS
Practice Address - Zip Code:96799
Practice Address - Country:US
Practice Address - Phone:684-633-1683
Practice Address - Fax:684-633-5107
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2008-06-10
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-06-10
Provider Licenses
StateLicense IDTaxonomies
ASE12345207R00000X
AS2009C207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH82220Medicare UPIN