Provider Demographics
NPI:1679672620
Name:NAVAL HOSPITAL GUAM
Entity Type:Organization
Organization Name:NAVAL HOSPITAL GUAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF DHA POSC
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-536-6650
Mailing Address - Street 1:BLDG 198
Mailing Address - Street 2:
Mailing Address - City:DEDEDO
Mailing Address - State:GU
Mailing Address - Zip Code:96540-1816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BLDG 198
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96540-1816
Practice Address - Country:US
Practice Address - Phone:671-355-4804
Practice Address - Fax:671-355-4033
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAVAL HOSPITAL GUAM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-22
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5411284OtherOTHER ID NUMBER-COMMERCIAL NUMBER