Healthcare Provider Details

I. General information

NPI: 1003762089
Provider Name (Legal Business Name): GUAM SEVENTH-DAY ADVENTIST CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 YPAO RD
TAMUNING GU
96913-3701
US

IV. Provider business mailing address

388 YPAO RD
TAMUNING GU
96913-3701
US

V. Phone/Fax

Practice location:
  • Phone: 671-646-8881
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: NIKOLA STODDART
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 671-646-8881