Healthcare Provider Details

I. General information

NPI: 1265738033
Provider Name (Legal Business Name): GOVERNMENT OF GUAM DEPARTMENT OF ADMINISTRATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 CHALAN KARETA
MANGILAO GU
96913-6304
US

IV. Provider business mailing address

123 CHALAN KARETA
MANGILAO GU
96913-6304
US

V. Phone/Fax

Practice location:
  • Phone: 671-735-7102
  • Fax: 671-734-5190
Mailing address:
  • Phone: 671-735-7102
  • Fax: 671-734-5190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ARTHUR U SAN AGUSTIN
Title or Position: ACTING DIRECTOR
Credential: MHR
Phone: 671-735-7102