Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 2026-C | AS |
NPI | 1558750919 |
---|---|
Provider Name | Hansel Ma. G. Villarica |
First Address | Pago Pago, AS 96799-4168 |
Second Address | Pago Pago, AS 96799-4168 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2015 |
Last Update Date | 29/05/2015 |