Healthcare Provider Details

I. General information

NPI: 1659562932
Provider Name (Legal Business Name): DEPARTMENT OF PUBLIC HEALTH AND SOCIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 W SANTA MONICA AVE
DEDEDO GU
96929-5286
US

IV. Provider business mailing address

520 W SANTA MONICA AVE
DEDEDO GU
96929-5286
US

V. Phone/Fax

Practice location:
  • Phone: 671-635-7492
  • Fax: 671-635-7493
Mailing address:
  • Phone: 671-635-7492
  • Fax: 671-635-7493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberDO0028
License Number StateGU

VIII. Authorized Official

Name: MR. PETERJOHN D CAMACHO
Title or Position: DIRECTOR
Credential: MPH
Phone: 671-735-7101