Provider Demographics
NPI:1922535996
Name:CENTER FOR WOMEN'S HEALTH, LLC
Entity Type:Organization
Organization Name:CENTER FOR WOMEN'S HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA-TRAM
Authorized Official - Middle Name:NGUYEN
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:671-988-7824
Mailing Address - Street 1:744 N MARINE CORPS DR STE A121
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-4426
Mailing Address - Country:US
Mailing Address - Phone:671-588-2394
Mailing Address - Fax:
Practice Address - Street 1:744 N MARINE CORPS DR STE A121
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-4426
Practice Address - Country:US
Practice Address - Phone:671-988-4093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-21
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM-1808207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUU0016123Medicaid