Healthcare Provider Details

I. General information

NPI: 1154537298
Provider Name (Legal Business Name): MARIANAS HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 06/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GHIYEGHI ST. SAN JOSE BLDG STE102 MARIANAS HEALTH LLC
SAIPAN MP
96950-8903
US

IV. Provider business mailing address

PO BOX 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 Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number10723-0004
License Number StateMP

VIII. Authorized Official

Name: MRS. EVELYN P. DE BELEN
Title or Position: BILLING MANAGER
Credential:
Phone: 670-233-4646