Organization Name: | PACIFIC MED & NEPHROLOGY |
NPI Number: | 1033391313 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SAIED SAFABAKHSH (PRESIDENT/OWNER) |
Mailing Address: | 633 Governor Carlos Camacho Rd Suite 205 Tamuning |
State: | GU US |
Postal Code: | 969133194 |
Phone Number: | 6716497232 |
Fax Number: | 6716497233 |
NPI Enumeration Date: | 11/29/2007 |
NPI Last Update Date: | 11/29/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM1300X |
License Number: | 261QM1300X |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GU |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Multi-Specialty |
Taxonomy Definition: |