Provider Demographics
NPI:1841581055
Name:MARIANAS MEDICAL CENTER LABORATORY INC
Entity Type:Organization
Organization Name:MARIANAS MEDICAL CENTER LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY OF THE CORPORATION
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:VILLAGOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:670-234-3925
Mailing Address - Street 1:PO BOX 5006
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950-5006
Mailing Address - Country:US
Mailing Address - Phone:670-234-3925
Mailing Address - Fax:670-234-3950
Practice Address - Street 1:BEACH ROAD, GARAPAN
Practice Address - Street 2:2ND FLOOR MMC BLDG.
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950-0000
Practice Address - Country:US
Practice Address - Phone:670-234-3925
Practice Address - Fax:670-234-3950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory