Organization
GUAM GERIATRICS CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STEPHANIE ANN MANIBUSAN UNTALAN (ADMINISTRATIVE ASSISTANT)
(671) 649-7232
Entity
Organization
Contact information
Practice address
633 GOV CARLOS G CAMACHO RD, STE. 205, TAMUNING, GU 96913-3194
(671) 649-7232
(671) 649-7233
Mailing address
633 GOV CARLOS G CAMACHO RD, STE. 205, TAMUNING, GU 96913-3194
(671) 649-7232
(671) 649-7233
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
M-1360
GU
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1063517639
PROVIDER NPI
GU
Enumeration date
10/17/2012
Last updated
04/18/2013
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