=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447579479
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARIANAS GLOBAL VENTURES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2010
-----------------------------------------------------
Last Update Date | 03/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | SUSUPE BEACH ROAD
-----------------------------------------------------
City | SAIPAN
-----------------------------------------------------
State | MP
-----------------------------------------------------
Zip | 96950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 670-285-8455
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 501856
-----------------------------------------------------
City | SAIPAN
-----------------------------------------------------
State | MP
-----------------------------------------------------
Zip | 96950-1856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 670-285-8455
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOAQUIN CAMACHO MANGLONA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 670-285-8455
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------