Healthcare Provider Details

I. General information

NPI: 1932568995
Provider Name (Legal Business Name): ONE LOVE PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2016
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 N MARINE CORPS DR C211
TAMUNING GU
96913-4426
US

IV. Provider business mailing address

PO BOX 9835
TAMUNING GU
96931-5835
US

V. Phone/Fax

Practice location:
  • Phone: 671-689-8422
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MICHAEL UM
Title or Position: OWNER
Credential: MD
Phone: 671-689-8422