Healthcare Provider Details

I. General information

NPI: 1619409513
Provider Name (Legal Business Name): NELSON DESOUZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U.S. NAVAL HOSPITAL GUAM FARENHOLT AVE, BLDG 50
AGANA HEIGHTS GU
96910
US

IV. Provider business mailing address

U.S. NAVAL HOSPITAL GUAM FARENHOLT AVE, BLDG 50
AGANA HEIGHTS GU
96910
US

V. Phone/Fax

Practice location:
  • Phone: 671-344-9775
  • Fax: 671-344-9327
Mailing address:
  • Phone: 671-344-9775
  • Fax: 671-344-9327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01081004A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: