Provider Demographics
NPI:1881929842
Name:HAFA ADAL SPECIALIST GROUP, LLP
Entity type:Organization
Organization Name:HAFA ADAL SPECIALIST GROUP, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:SABLAN
Authorized Official - Last Name:NOKET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:671-647-4542
Mailing Address - Street 1:280 PALE SAN VITORES RD
Mailing Address - Street 2:SUNFLOWER VILLA
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3615
Mailing Address - Country:US
Mailing Address - Phone:671-647-4542
Mailing Address - Fax:671-647-4558
Practice Address - Street 1:280 PALE SAN VITORES RD
Practice Address - Street 2:SUNFLOWER VILLA
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3615
Practice Address - Country:US
Practice Address - Phone:671-647-4542
Practice Address - Fax:671-647-4558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUG67597Medicare UPIN