Healthcare Provider Details

I. General information

NPI: 1396017489
Provider Name (Legal Business Name): SAGAN HINEMLO' FAMILY CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STE 104 GHIYEGHI ST. SAN JOSE
SAIPAN MP
96950-8903
US

IV. Provider business mailing address

POB 10003 PMB 1341
SAIPAN MP
96950-8903
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. GEORGE J. CRUZ
Title or Position: PRESIDENT
Credential:
Phone: 670-233-4646