Healthcare Provider Details

I. General information

NPI: 1528714896
Provider Name (Legal Business Name): BLUE CONTINENT HEALTHCARE GUAM MEDICAL CITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 02/25/2022
Certification Date: 02/15/2022
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:
Mailing address:
  • Phone: 671-645-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALAN FUNTANILLA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 671-645-5500