Healthcare Provider Details

I. General information

NPI: 1487031613
Provider Name (Legal Business Name): OFFICE OF LEOPOLDO ARCILLA , JR.,MD.,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1757 ARMY DR STE 108
TAMUNING GU
96913-1260
US

IV. Provider business mailing address

1757 ARMY DR STE 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 TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberM-1565
License Number StateGU

VIII. Authorized Official

Name: DR. LEOPOLDO CLAVA ARCILLA JR.
Title or Position: PRESIDENT/PHYSICIAN
Credential: MD
Phone: 671-483-6766