Provider Demographics
NPI:1487031613
Name:OFFICE OF LEOPOLDO ARCILLA , JR.,MD.,PC
Entity Type:Organization
Organization Name:OFFICE OF LEOPOLDO ARCILLA , JR.,MD.,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LEOPOLDO
Authorized Official - Middle Name:CLAVA
Authorized Official - Last Name:ARCILLA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:671-483-6766
Mailing Address - Street 1:1757 ARMY DR STE 108
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-1260
Mailing Address - Country:US
Mailing Address - Phone:671-647-4533
Mailing Address - Fax:671-647-1110
Practice Address - Street 1:1757 ARMY DR STE 108
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-1260
Practice Address - Country:US
Practice Address - Phone:671-647-4533
Practice Address - Fax:671-647-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM-1565261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GU1021Medicaid
GU1021Medicaid