1952670382 NPI number — CANCER CENTER OF GUAM LLP SAMUEL J FRIEDMAN GEN PTR

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952670382 NPI number — CANCER CENTER OF GUAM LLP SAMUEL J FRIEDMAN GEN PTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CANCER CENTER OF GUAM LLP SAMUEL J FRIEDMAN GEN PTR
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952670382
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
633 GOV. CARLOS CAMACHO RD., B5
Provider Second Line Business Mailing Address:
GUAM MEDICAL PLAZA
Provider Business Mailing Address City Name:
TAMUNING
Provider Business Mailing Address State Name:
GU
Provider Business Mailing Address Postal Code:
96913-3194
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
671-647-4656
Provider Business Mailing Address Fax Number:
671-647-4660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
416 CHALAN SAN ANTONIO
Provider Second Line Business Practice Location Address:
GOOD SAMARITAN BUILDING
Provider Business Practice Location Address City Name:
TAMUNING
Provider Business Practice Location Address State Name:
GU
Provider Business Practice Location Address Postal Code:
96913-3601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
671-647-4656
Provider Business Practice Location Address Fax Number:
671-647-4660
Provider Enumeration Date:
12/13/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LEON GUERRERO
Authorized Official First Name:
DIANA
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
671-647-4656

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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