Provider Demographics
NPI:1124782701
Name:GUAM E.N.T., LLC
Entity type:Organization
Organization Name:GUAM E.N.T., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TECHAIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:671-989-1368
Mailing Address - Street 1:341 S MARINE CORPS DR STE 104
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3970
Mailing Address - Country:US
Mailing Address - Phone:671-989-1368
Mailing Address - Fax:671-989-2360
Practice Address - Street 1:341 S MARINE CORPS DR STE 104
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3970
Practice Address - Country:US
Practice Address - Phone:671-989-1368
Practice Address - Fax:671-989-2360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty