1487856332 NPI number — MICHELLE THERESE AGUIGUI SANNICOLAS PHARMD

Table of content: MICHELLE THERESE AGUIGUI SANNICOLAS PHARMD (NPI 1487856332)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487856332 NPI number — MICHELLE THERESE AGUIGUI SANNICOLAS PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANNICOLAS
Provider First Name:
MICHELLE
Provider Middle Name:
THERESE AGUIGUI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DELOSO
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
SAN NICOLAS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1487856332
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
128 ATIS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA RITA
Provider Business Mailing Address State Name:
GU
Provider Business Mailing Address Postal Code:
96915-1512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
671-565-5191
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
#162 AS APMAN DRIVE
Provider Second Line Business Practice Location Address:
INARAJAN COMMUNITY HEALTH CENTER
Provider Business Practice Location Address City Name:
INARAJAN
Provider Business Practice Location Address State Name:
GU
Provider Business Practice Location Address Postal Code:
96929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
671-828-7501
Provider Business Practice Location Address Fax Number:
671-828-7504
Provider Enumeration Date:
06/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PH092 , registered in the state of GU ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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