Individual
MA FARAH DIVA LIBO ON CUNANAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
120 NORTH HASMIN COURT, DEDEDO, GU 96929
(671) 858-5758
Mailing address
120 NORTH HASMIN COURT, DEDEDO, GU 96929
(671) 858-5758
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
027838
NY
225100000X
Physical Therapist
Primary
PT83
GU
Other
Enumeration date
03/19/2007
Last updated
08/08/2016
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