Healthcare Provider Details

I. General information

NPI: 1366786865
Provider Name (Legal Business Name): GUAM MEDICAL EQUIPMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2012
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 CHALAN SAN ANTONIO SUITE 102-B PHOTO TOWN PLAZA,
TAMUNING GU
96913
US

IV. Provider business mailing address

353 CHALAN SAN ANTONIO SUITE 102-B PHOTO TOWN PLAZA,
TAMUNING GU
96913
US

V. Phone/Fax

Practice location:
  • Phone: 671-649-4633
  • Fax: 671-649-4636
Mailing address:
  • Phone: 671-649-4633
  • Fax: 671-649-4636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. CESAR SAYSON VILLANUEVA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 671-788-8200