Provider Demographics
NPI:1215378393
Name:DOTIMAS, CARLO ROMULO S (RPT)
Entity Type:Individual
Prefix:MR
First Name:CARLO ROMULO
Middle Name:S
Last Name:DOTIMAS
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9663
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96931-5663
Mailing Address - Country:US
Mailing Address - Phone:671-646-6877
Mailing Address - Fax:
Practice Address - Street 1:KIM'S BLDG GUALO RAI MIDDLE ROAD
Practice Address - Street 2:STE 6
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:670-323-6780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist