Provider Demographics
NPI:1659816924
Name:THE DOCTORS' CLINIC
Entity type:Organization
Organization Name:THE DOCTORS' CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC NURSE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:FRANQUEZ
Authorized Official - Last Name:DUENAS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:671-649-5018
Mailing Address - Street 1:PO BOX 11409
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96931-1409
Mailing Address - Country:US
Mailing Address - Phone:671-649-5018
Mailing Address - Fax:671-647-0832
Practice Address - Street 1:851 GOV CARLOS G CAMACHO RD
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:671-649-5018
Practice Address - Fax:671-647-0832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM638261QP2300X
GUM675261QP2300X
GUM464261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GU1740336247Medicare UPIN
GU1033264072Medicare UPIN
GU1831244888Medicare UPIN