Provider Demographics
NPI:1275920316
Name:PMC ISLA HEALTH SYSTEM
Entity Type:Organization
Organization Name:PMC ISLA HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMBROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:671-647-6201
Mailing Address - Street 1:177-C CHALAN PASAHERU
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GUAM
Mailing Address - Zip Code:96913
Mailing Address - Country:AX
Mailing Address - Phone:671-647-6201
Mailing Address - Fax:671-647-0045
Practice Address - Street 1:177-C CHALAN PASAHERU
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GUAM
Practice Address - Zip Code:96913
Practice Address - Country:AX
Practice Address - Phone:671-647-6201
Practice Address - Fax:671-647-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-15
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUMOO1035261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center