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General NPI Number Information
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NPI Number | 1841007556
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Entity Type | Organization
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Legal Business Name | ELEMENT 1B, LLC
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 543 GUMA YUOS STREET
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City | TAMUNING
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State | GU
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Zip | 96913
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Country | US
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Telephone | 671-864-5124
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Fax |
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Provider Business Mailing Address
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Address Line | 385 FARENHOLT AVE
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City | TAMUNING
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State | GU
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Zip | 96913-3106
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Country | US
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Telephone | 671-864-5124
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAZZEDYPAUL M CAMPOS
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Credential |
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Telephone | 671-864-5124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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