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General NPI Number Information
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NPI Number | 1326447939
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Entity Type | Organization
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Legal Business Name | GUAM HEALTHCARE DEVELOPMENT INCORPORATED
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Dates
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Enumeration Date | 08/19/2014
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Last Update Date | 10/27/2024
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Provider Practice Location Address
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Address Line | 133 ROUTE 3
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City | DEDEDO
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State | GU
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Zip | 96929-6911
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Country | US
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Telephone | 671-645-5500
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Fax | 671-645-5549
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Provider Business Mailing Address
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Address Line | 133 ROUTE 3
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City | DEDEDO
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State | GU
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Zip | 96929-6911
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Country | US
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Telephone | 671-645-5500
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Fax | 671-645-5549
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | ALEXANDER D. WIELAARD
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Credential | MD
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Telephone | 706-306-4668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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