Provider Demographics
NPI:1699957274
Name:GUAM SLEEP CENTER, LLC
Entity type:Organization
Organization Name:GUAM SLEEP CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIVINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MESA
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT, RST
Authorized Official - Phone:671-647-6669
Mailing Address - Street 1:535 N MARINE CORPS DR STE 1A
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-4112
Mailing Address - Country:US
Mailing Address - Phone:671-647-6669
Mailing Address - Fax:671-647-6277
Practice Address - Street 1:535 N. MARINE CORPS DRIVE
Practice Address - Street 2:UNIT 1A
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-647-6669
Practice Address - Fax:671-647-6277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X
GU13-200701593-001261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty