Healthcare Provider Details

I. General information

NPI: 1366467110
Provider Name (Legal Business Name): HEALTH PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KULOT DE ROSA DR., CHALAN KIYA POB 502878
SAIPAN MP
96950
US

IV. Provider business mailing address

KULOT DE ROSA DR., CHALAN KIYA POB 502878
SAIPAN MP
96950
US

V. Phone/Fax

Practice location:
  • Phone: 670-234-2901
  • Fax: 670-234-2906
Mailing address:
  • Phone: 670-234-2901
  • Fax: 670-234-2906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number777 0001 1
License Number StateMP

VIII. Authorized Official

Name: DR. VICENTE SABLAN ALDAN
Title or Position: PRESIDENT/DIRECTOR
Credential: M.D.
Phone: 670-234-2901