Healthcare Provider Details

I. General information

NPI: 1396429650
Provider Name (Legal Business Name): ANNA LOU CARANAY GARCES GENRAL MANAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 CHALAN SAN ANTONIO STE 102
TAMUNING GU
96913-3601
US

IV. Provider business mailing address

428 CHALAN SAN ANTONIO STE 102
TAMUNING GU
96913-3601
US

V. Phone/Fax

Practice location:
  • Phone: 671-637-5433
  • Fax: 671-633-5433
Mailing address:
  • Phone: 671-637-5433
  • Fax: 671-633-5433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number660798903
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: