Healthcare Provider Details

I. General information

NPI: 1447579479
Provider Name (Legal Business Name): MARIANAS GLOBAL VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2010
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SUSUPE BEACH ROAD
SAIPAN MP
96950
US

IV. Provider business mailing address

PO BOX 501856
SAIPAN MP
96950-1856
US

V. Phone/Fax

Practice location:
  • Phone: 670-285-8455
  • Fax:
Mailing address:
  • Phone: 670-285-8455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: JOAQUIN CAMACHO MANGLONA
Title or Position: PRESIDENT
Credential:
Phone: 670-285-8455