Healthcare Provider Details

I. General information

NPI: 1003000761
Provider Name (Legal Business Name): PATRICIA LEON GUERRERO TAIMANGLO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PATRICIA TAIMANGLO PIER PHD

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 S MARINE CORPS DRIVE SUITE 219 GITC BLDG
TAMUNING GU
96913
US

IV. Provider business mailing address

590 S MARINE CORPS DRIVE SUITE 219 GITC BLDG
TAMUNING GU
96914
US

V. Phone/Fax

Practice location:
  • Phone: 671-649-2080
  • Fax: 671-649-2083
Mailing address:
  • Phone: 671-649-2080
  • Fax: 671-649-2082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberCP000022
License Number StateGU
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY705
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: