| Organization Name: | CNM MEDICAL CLINIC |
| NPI Number: | 1770789331 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARYANN BULALA (LEAD FINANCIAL TECH) |
| Mailing Address: | Building 6 Chapel Road Santa Rita |
| State: | GU US |
| Postal Code: | 96538 |
| Phone Number: | 6713397118 |
| Fax Number: | |
| NPI Enumeration Date: | 06/21/2007 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1100X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Military/U.S. Coast Guard Outpatient |
| Taxonomy Definition: | The Defense Health Program or U.S. Coast Guard funded |