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General NPI Number Information
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NPI Number | 1538544713
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Entity Type | Organization
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Legal Business Name | EXPRESSCARE HEALTH AND SKIN CENTER INC.
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Dates
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Enumeration Date | 07/29/2015
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Last Update Date | 08/21/2015
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Provider Practice Location Address
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Address Line | 302 SOUTH ROUTE 4 SUITE 207
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City | HAGATNA
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State | GU
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Zip | 96932
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Country | US
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Telephone | 671-477-2873
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Fax | 671-472-2873
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Provider Business Mailing Address
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Address Line | 302 SOUTH ROUTE 4 SUITE 207
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City | HAGATNA
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State | GU
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Zip | 96932
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Country | US
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Telephone | 671-477-2873
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Fax | 671-472-2873
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Authorized Official
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Title or Position | PRESIDENT
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Name | JITKA LOM
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Credential | M.D.
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Telephone | 671-477-2873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0000X
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Taxonomy Name | Adolescent Medicine (Family Medicine) Physician
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License Number | M1288
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License Number State | GU
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