Provider Demographics
NPI:1780125047
Name:AMBC P.C.
Entity type:Organization
Organization Name:AMBC P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA CHELA
Authorized Official - Middle Name:ARANA
Authorized Official - Last Name:MARIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:671-637-8112
Mailing Address - Street 1:255 FARENHOLT AVE
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3209
Mailing Address - Country:US
Mailing Address - Phone:671-637-8112
Mailing Address - Fax:671-637-8113
Practice Address - Street 1:330 W MARINE CORPS DR
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-5924
Practice Address - Country:US
Practice Address - Phone:671-637-8112
Practice Address - Fax:671-637-8113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM-1590261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
GU693Medicaid
GU693Medicaid