Provider Demographics
NPI:1134156763
Name:HEALTH PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:HEALTH PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VICENTE
Authorized Official - Middle Name:SABLAN
Authorized Official - Last Name:ALDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:670-234-2901
Mailing Address - Street 1:KULOT DE ROSA DR., CHALAN KIYA
Mailing Address - Street 2:P.O. BOX 5002878
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950-2878
Mailing Address - Country:US
Mailing Address - Phone:670-234-2901
Mailing Address - Fax:670-234-2906
Practice Address - Street 1:KULOT DE ROSA DR., CHALAN KIYA
Practice Address - Street 2:
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:670-234-2901
Practice Address - Fax:670-234-2906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
55879Medicare ID - Type Unspecified