Healthcare Provider Details

I. General information

NPI: 1073038204
Provider Name (Legal Business Name): SYDNEY LEXTER N. BIAG RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MARIANAS HEALTH LLC BLDG STE 102 GHIYEGHI ST. SAN JOSE
SAIPAN MP
96950-8903
US

IV. Provider business mailing address

PO BOX 10003 PMB 1341
SAIPAN MP
96950
US

V. Phone/Fax

Practice location:
  • Phone: 670-233-4646
  • Fax: 670-233-4646
Mailing address:
  • Phone: 670-233-4646
  • Fax: 670-233-4648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0047
License Number StateMP

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: