Individual
MISS MA IVY CLEMENTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
PO BOX LBJ, PAGO PAGO, AS 96799-0010
(684) 633-1222
(684) 633-2893
Mailing address
PO BOX LBJ, PAGO PAGO, AS 96799-0010
(684) 633-1222
(684) 633-2893
Taxonomy
Speciality
Code
Description
License number
State
246Q00000X
Pathology Specialist/Technologist
Primary
2061-C
AS
Other
Enumeration date
08/28/2013
Last updated
08/28/2013
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