Healthcare Provider Details

I. General information

NPI: 1003382854
Provider Name (Legal Business Name): COMMONWEALTH HEALTHCARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2018
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAN JOSE VILLAGE CORNER OF CANAL STREET & BROADWAY
TINIAN MP
96952
US

IV. Provider business mailing address

PO BOX 446
TINIAN MP
96952-0446
US

V. Phone/Fax

Practice location:
  • Phone: 670-433-9233
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ESTHER L MUNA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 670-234-8950