Healthcare Provider Details

I. General information

NPI: 1962209395
Provider Name (Legal Business Name): WESTCARE PACIFIC ISLANDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 S MARINE CORPS DR STE 102
TAMUNING GU
96913-3572
US

IV. Provider business mailing address

402 E MARINE CORPS DR STE 200
HAGATNA GU
96910-5184
US

V. Phone/Fax

Practice location:
  • Phone: 671-472-0218
  • Fax:
Mailing address:
  • Phone: 671-472-0218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AJA RAMOS
Title or Position: COO
Credential:
Phone: 671-472-0218