Provider Demographics
NPI:1487601183
Name:GANACIAS-ACUNA, EDNA (MD)
Entity type:Individual
Prefix:DR
First Name:EDNA
Middle Name:
Last Name:GANACIAS-ACUNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EDNA
Other - Middle Name:FARALAN
Other - Last Name:ACUNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:133 ROUTE 3
Mailing Address - Street 2:
Mailing Address - City:DEDEDO
Mailing Address - State:GU
Mailing Address - Zip Code:96929-6911
Mailing Address - Country:US
Mailing Address - Phone:671-645-5500
Mailing Address - Fax:671-645-5549
Practice Address - Street 1:133 ROUTE 3
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-6911
Practice Address - Country:US
Practice Address - Phone:671-645-5500
Practice Address - Fax:671-645-5549
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM-1751207Q00000X, 2083P0901X, 251E00000X, 2083P0011X
TXE3693208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BX258OtherBLUE CROSS
TX128212106Medicaid
TX8F10388Medicare PIN
TX128212106Medicaid
TX128212106Medicaid