Healthcare Provider Details

I. General information

NPI: 1760497309
Provider Name (Legal Business Name): MARIA MELINDA BERNALES SANGALANG D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELINDA BERNALES SANGALANG D.P.M.

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 10/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 GOV CARLOS G CAMACHO RD SUITE 212
TAMUNING GU
96913-3195
US

IV. Provider business mailing address

633 GOV CARLOS CAMACHO RD SUITE 212
TAMUNING GUAM
96913
UM

V. Phone/Fax

Practice location:
  • Phone: 671-646-3375
  • Fax: 671-649-2266
Mailing address:
  • Phone: 671-777-2412
  • Fax: 671-649-2266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD-00006
License Number StateGU
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00645
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO-179
License Number StateHI
# 4
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number645
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: