Healthcare Provider Details

I. General information

NPI: 1023428042
Provider Name (Legal Business Name): JESSE MASGA TUDELA RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LOWER NAVY HILL ROAD
SAIPAN MP
96950-0409
US

IV. Provider business mailing address

PO BOX 500515
SAIPAN MP
96950-0515
US

V. Phone/Fax

Practice location:
  • Phone: 670-234-8950
  • Fax: 670-236-8756
Mailing address:
  • Phone: 670-234-8950
  • Fax: 670-236-8756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: