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General NPI Number Information
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NPI Number | 1922435320
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Entity Type | Organization
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Legal Business Name | MARIANAS MEDICAL PROVIDERS, LLC
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Dates
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Enumeration Date | 09/30/2013
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Last Update Date | 09/30/2013
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Provider Practice Location Address
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Address Line | 182 CHALAN MACAJNA
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City | AGANA HEIGHTS
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State | GU
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Zip | 96910-6113
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Country | US
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Telephone | 671-689-2128
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Fax | 671-633-4452
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Provider Business Mailing Address
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Address Line | P.O. BOX 3431
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City | HAGATNA
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State | GU
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Zip | 96932-8901
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Country | US
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Telephone | 671-689-2128
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Fax | 671-633-4452
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. PAULINE SA LIZAMA
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Credential |
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Telephone | 671-689-2128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State | GU
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