Healthcare Provider Details

I. General information

NPI: 1881413771
Provider Name (Legal Business Name): FAMALAOAN WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 N MARINE CORPS DR STE 121
TAMUNING GU
96913-4426
US

IV. Provider business mailing address

744 N MARINE CORPS DR STE 121
TAMUNING GU
96913-4426
US

V. Phone/Fax

Practice location:
  • Phone: 671-487-5291
  • Fax:
Mailing address:
  • Phone: 671-588-2394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELLI JARRETT
Title or Position: MEMBER
Credential: MD
Phone: 671-588-2394