Provider Demographics
NPI:1962968339
Name:TAUAESE, ISALEI TIUMALU
Entity type:Individual
Prefix:
First Name:ISALEI
Middle Name:TIUMALU
Last Name:TAUAESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12980 DARTMOUTH CT
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-7220
Mailing Address - Country:US
Mailing Address - Phone:760-881-9910
Mailing Address - Fax:
Practice Address - Street 1:3532 MONROE ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-6322
Practice Address - Country:US
Practice Address - Phone:760-881-9910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer