Provider Demographics
NPI:1831244888
Name:DUENAS, VINCENT A (MD)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:A
Last Name:DUENAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 SOUTH SABANA DRIVE
Mailing Address - Street 2:
Mailing Address - City:BARRIGADA HEIGHTS
Mailing Address - State:GU
Mailing Address - Zip Code:96913-0000
Mailing Address - Country:US
Mailing Address - Phone:671-637-0727
Mailing Address - Fax:671-647-0832
Practice Address - Street 1:851 GOVERNOR CARLOS CAMACHO ROAD
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3153
Practice Address - Country:US
Practice Address - Phone:671-300-0840
Practice Address - Fax:671-647-0832
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM638207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GU611Medicaid
GUM638OtherGUAM BOARD OF MEDICAL EXAMINERS LICENSURE
GUM638OtherGUAM BOARD OF MEDICAL EXAMINERS LICENSURE
GU611Medicaid