Healthcare Provider Details

I. General information

NPI: 1952670382
Provider Name (Legal Business Name): CANCER CENTER OF GUAM LLP SAMUEL J FRIEDMAN GEN PTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 CHALAN SAN ANTONIO GOOD SAMARITAN BUILDING
TAMUNING GU
96913-3601
US

IV. Provider business mailing address

633 GOV. CARLOS CAMACHO RD., B5 GUAM MEDICAL PLAZA
TAMUNING GU
96913-3194
US

V. Phone/Fax

Practice location:
  • Phone: 671-647-4656
  • Fax: 671-647-4660
Mailing address:
  • Phone: 671-647-4656
  • Fax: 671-647-4660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DIANA LEON GUERRERO
Title or Position: BUSINESS MANAGER
Credential:
Phone: 671-647-4656