Healthcare Provider Details

I. General information

NPI: 1841581055
Provider Name (Legal Business Name): MARIANAS MEDICAL CENTER LABORATORY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BEACH ROAD, GARAPAN 2ND FLOOR MMC BLDG.
SAIPAN MP
96950-0000
US

IV. Provider business mailing address

PO BOX 5006
SAIPAN MP
96950-5006
US

V. Phone/Fax

Practice location:
  • Phone: 670-234-3925
  • Fax: 670-234-3950
Mailing address:
  • Phone: 670-234-3925
  • Fax: 670-234-3950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MS. ANGELINA L VILLAGOMEZ
Title or Position: SECRETARY OF THE CORPORATION
Credential:
Phone: 670-234-3925