Healthcare Provider Details

I. General information

NPI: 1316017270
Provider Name (Legal Business Name): CHERYL TAN NAVARRO-MCGUINNESS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 PROFESSIONAL PARK DR SUITE A
MOORESVILLE NC
28117-6540
US

IV. Provider business mailing address

PO BOX 602148
CHARLOTTE NC
28260-2148
US

V. Phone/Fax

Practice location:
  • Phone: 704-663-4443
  • Fax: 704-663-6999
Mailing address:
  • Phone: 704-663-4443
  • Fax: 704-663-6999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2006-01750
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: