Individual
CRYSTALLY HEART GUANGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
212 FARENHOLT AVE, TAMUNING, GU 96913
(671) 483-4747
Mailing address
212 FARENHOLT AVE, TAMUNING, GU 96913
(671) 483-4747
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-20-137188
GU
Other
Enumeration date
10/14/2020
Last updated
10/14/2020
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