Healthcare Provider Details

I. General information

NPI: 1801462890
Provider Name (Legal Business Name): CANOVAS & SONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 N MARINE CORPS DR # C-109
TAMUNING GU
96913-4426
US

IV. Provider business mailing address

1640 ARMY DR
DEDEDO GU
96929-6533
US

V. Phone/Fax

Practice location:
  • Phone: 671-633-6332
  • Fax: 671-633-6333
Mailing address:
  • Phone: 671-633-6332
  • Fax: 671-633-6333

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: CHRISTINE T CANOVAS
Title or Position: ACCOUNTANT
Credential:
Phone: 671-687-8771