Healthcare Provider Details

I. General information

NPI: 1487601183
Provider Name (Legal Business Name): EDNA GANACIAS-ACUNA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EDNA FARALAN ACUNA M.D.

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 ROUTE 3
DEDEDO GU
96929-6911
US

IV. Provider business mailing address

133 ROUTE 3
DEDEDO GU
96929-6911
US

V. Phone/Fax

Practice location:
  • Phone: 671-645-5500
  • Fax: 671-645-5549
Mailing address:
  • Phone: 671-645-5500
  • Fax: 671-645-5549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM-1751
License Number StateGU
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberM-1751
License Number StateGU
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberE3693
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberM-1751
License Number StateGU
# 5
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberM-1751
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: