Provider Demographics
NPI:1992441539
Name:VISPERAS, FAALAULA TRICIA
Entity type:Individual
Prefix:
First Name:FAALAULA
Middle Name:TRICIA
Last Name:VISPERAS
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 1:1104 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-2759
Mailing Address - Country:US
Mailing Address - Phone:907-375-3276
Mailing Address - Fax:
Practice Address - Street 1:1104 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-2759
Practice Address - Country:US
Practice Address - Phone:907-375-3276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty