Provider Demographics
NPI:1831623537
Name:FATAI, KAVEINGA
Entity type:Individual
Prefix:MRS
First Name:KAVEINGA
Middle Name:
Last Name:FATAI
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KAVEINGA
Other - Middle Name:
Other - Last Name:FUAPAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:268 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-4724
Mailing Address - Country:US
Mailing Address - Phone:510-850-1441
Mailing Address - Fax:
Practice Address - Street 1:268 GRAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-4724
Practice Address - Country:US
Practice Address - Phone:510-850-1441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker