Provider Demographics
NPI:1265738033
Name:GOVERNMENT OF GUAM DEPARTMENT OF ADMINISTRATION
Entity type:Organization
Organization Name:GOVERNMENT OF GUAM DEPARTMENT OF ADMINISTRATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACTING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:U
Authorized Official - Last Name:SAN AGUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MHR
Authorized Official - Phone:671-735-7102
Mailing Address - Street 1:123 CHALAN KARETA
Mailing Address - Street 2:
Mailing Address - City:MANGILAO
Mailing Address - State:GU
Mailing Address - Zip Code:96913-6304
Mailing Address - Country:US
Mailing Address - Phone:671-735-7102
Mailing Address - Fax:671-734-5190
Practice Address - Street 1:123 CHALAN KARETA
Practice Address - Street 2:
Practice Address - City:MANGILAO
Practice Address - State:GU
Practice Address - Zip Code:96913-6304
Practice Address - Country:US
Practice Address - Phone:671-735-7102
Practice Address - Fax:671-734-5190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GU251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare