Healthcare Provider Details

I. General information

NPI: 1386990141
Provider Name (Legal Business Name): MARIANAS MEDICAL SUPPLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PALE ARNOLD RD GUALO RAI M&H BUILDING
SAIPAN MP
96950-1877
US

IV. Provider business mailing address

PO BOX 501877
SAIPAN MP
96950-1877
US

V. Phone/Fax

Practice location:
  • Phone: 670-233-6671
  • Fax: 670-233-6672
Mailing address:
  • Phone: 670-233-6671
  • Fax: 670-233-6672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANNIE MARIE BENAVENTE
Title or Position: OWNER/MEMBER
Credential:
Phone: 670-483-2663