Healthcare Provider Details

I. General information

NPI: 1043760168
Provider Name (Legal Business Name): M3D PRO PACIFIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1779 ARMY DR STE 205
TAMUNING GU
96913-1278
US

IV. Provider business mailing address

1779 ARMY DRIVE SUITE 205
TAMUNING GUAM
96913
UM

V. Phone/Fax

Practice location:
  • Phone: 671-486-9200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number332B00000X
License Number StateGU

VIII. Authorized Official

Name: MR. EDUARDO ABESAMIS MANUEL JR.
Title or Position: GENERAL MANAGER
Credential:
Phone: 671-486-9200