Provider Demographics
NPI:1013422435
Name:HAGANTA CLINIC, PC
Entity Type:Organization
Organization Name:HAGANTA CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:671-479-6363
Mailing Address - Street 1:277 W CHALAN SANTO PAPA
Mailing Address - Street 2:
Mailing Address - City:HAGATNA
Mailing Address - State:GU
Mailing Address - Zip Code:96910-5115
Mailing Address - Country:US
Mailing Address - Phone:671-479-6363
Mailing Address - Fax:671-479-4329
Practice Address - Street 1:277 W CHALAN SANTO PAPA
Practice Address - Street 2:
Practice Address - City:HAGATNA
Practice Address - State:GU
Practice Address - Zip Code:96910-5115
Practice Address - Country:US
Practice Address - Phone:671-479-6363
Practice Address - Fax:671-479-4329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center