Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | C-27 | GU |
NPI | 1326459520 |
---|---|
Provider Name | Albert Joseph Dimalanta |
First Address | Tamuning, GU 96913-3510 |
Second Address | Tamuning, GU 96913-3510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2014 |
Last Update Date | 11/05/2014 |