Healthcare Provider Details

I. General information

NPI: 1649831223
Provider Name (Legal Business Name): ALLAN CAGAMPAN BUENAVENTURA FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 E APACHE BLVD
TEMPE AZ
85281-5817
US

IV. Provider business mailing address

909 E APACHE BLVD
TEMPE AZ
85281-5817
US

V. Phone/Fax

Practice location:
  • Phone: 480-967-0799
  • Fax:
Mailing address:
  • Phone: 480-679-0799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number231003
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: