Healthcare Provider Details

I. General information

NPI: 1356937023
Provider Name (Legal Business Name): SAIPAN RENAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2020
Last Update Date: 12/17/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHALAN LAULAU, BEACH ROAD
SAIPAN MP
96950-0170
US

IV. Provider business mailing address

PO BOX 500170
SAIPAN MP
96950-0170
US

V. Phone/Fax

Practice location:
  • Phone: 670-234-4747
  • Fax:
Mailing address:
  • Phone: 670-234-4747
  • Fax: 670-235-2273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEVIN CAMACHO GUERRERO
Title or Position: PRESIDENT
Credential:
Phone: 670-234-4747