Provider Demographics
NPI:1659562932
Name:DEPARTMENT OF PUBLIC HEALTH AND SOCIAL SERVICES
Entity Type:Organization
Organization Name:DEPARTMENT OF PUBLIC HEALTH AND SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETERJOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CAMACHO
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:671-735-7101
Mailing Address - Street 1:520 W SANTA MONICA AVE
Mailing Address - Street 2:
Mailing Address - City:DEDEDO
Mailing Address - State:GU
Mailing Address - Zip Code:96929-5286
Mailing Address - Country:US
Mailing Address - Phone:671-635-7492
Mailing Address - Fax:671-635-7493
Practice Address - Street 1:520 W SANTA MONICA AVE
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-5286
Practice Address - Country:US
Practice Address - Phone:671-635-7492
Practice Address - Fax:671-635-7493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUDO0028251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare