Healthcare Provider Details

I. General information

NPI: 1457521429
Provider Name (Legal Business Name): LUCIA S. CORPUZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 08/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

M & H BUILDING GUALO RAI
SAIPAN MP
96950-0000
US

IV. Provider business mailing address

PMB 737 BOX 10003 GUALO RAI
SAIPAN MP
96950-0000
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. LUCIA SALAS CORPUZ
Title or Position: OWNER
Credential:
Phone: 670-233-6671