Healthcare Provider Details

I. General information

NPI: 1144587692
Provider Name (Legal Business Name): JOAQUIN MUNA MANGLONA PROPRIETOR/OWNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 04/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SUSUPE BEACH ROAD, JM MANGLONA BUILDING UNIT 2 JOAQUIN M. MANGLONA DBA UNIVERSAL HEALTH CARE
SAIPAN MP
96950-8903
US

IV. Provider business mailing address

P.O. BOX 500732 CHALAN KANOA
SAIPAN MP
96950-8903
US

V. Phone/Fax

Practice location:
  • Phone: 670-235-7642
  • Fax: 670-235-7642
Mailing address:
  • Phone: 670-235-7642
  • Fax: 670-235-7642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number380-0014-1
License Number StateMP

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: