Healthcare Provider Details

I. General information

NPI: 1902160211
Provider Name (Legal Business Name): GUAM MEDICAL HEALTH CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1757 ARMY DR SUITE 108
TAMUNING GU
96913-1260
US

IV. Provider business mailing address

1757 ARMY DR SUITE 108
TAMUNING GU
96913-1260
US

V. Phone/Fax

Practice location:
  • Phone: 671-647-4533
  • Fax: 671-647-1110
Mailing address:
  • Phone: 671-647-4533
  • Fax: 671-647-1110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberM-1705
License Number StateGU
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM1705
License Number StateGU

VIII. Authorized Official

Name: MRS. EDEN E VILLA
Title or Position: PHYSICIAN/DIRECTOR
Credential: M.D.
Phone: 671-647-4533