Provider Demographics
NPI:1083412480
Name:MALIUKAETAU, AHOLOTU A FAFINE
Entity type:Individual
Prefix:
First Name:AHOLOTU
Middle Name:A FAFINE
Last Name:MALIUKAETAU
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16018 42ND AVE S
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-3011
Mailing Address - Country:US
Mailing Address - Phone:510-586-5914
Mailing Address - Fax:
Practice Address - Street 1:16018 42ND AVE S
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-3011
Practice Address - Country:US
Practice Address - Phone:510-586-5914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIHS.FS.61612193374U00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty