Provider Demographics
NPI:1902683972
Name:LAQERE, SIRILO NADAVELEVU (MBBS)
Entity Type:Individual
Prefix:DR
First Name:SIRILO
Middle Name:NADAVELEVU
Last Name:LAQERE
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 998214
Mailing Address - Street 2:
Mailing Address - City:PAGO PAGO
Mailing Address - State:AS
Mailing Address - Zip Code:96799-6312
Mailing Address - Country:US
Mailing Address - Phone:684-782-7977
Mailing Address - Fax:
Practice Address - Street 1:3965,TAFUNA COMMUNITY HEALTH CENTER, PETESA RD
Practice Address - Street 2:TA'U COMMUNITY HEALTH CLINIC
Practice Address - City:PAGOPAGO
Practice Address - State:AS
Practice Address - Zip Code:96799
Practice Address - Country:US
Practice Address - Phone:684-633-5871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AS4115C207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine