Healthcare Provider Details

I. General information

NPI: 1992987952
Provider Name (Legal Business Name): TUMON MEDICAL OFFICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 CARLOS LN CARLOS HEIGHTS
TAMUNING GU
96913-4339
US

IV. Provider business mailing address

125 CARLOS LN CARLOS HEIGHTS
TAMUNING GU
96913-4339
US

V. Phone/Fax

Practice location:
  • Phone: 671-649-5052
  • Fax:
Mailing address:
  • Phone: 671-649-5052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM001195
License Number StateGU

VIII. Authorized Official

Name: DR. PATRICK SANTOS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 671-649-5052