Provider Demographics
NPI:1003000761
Name:TAIMANGLO, PATRICIA LEON GUERRERO (PHD)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:LEON GUERRERO
Last Name:TAIMANGLO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:TAIMANGLO
Other - Last Name:PIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:590 S MARINE CORPS DRIVE
Mailing Address - Street 2:SUITE 219 GITC BLDG
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96914
Mailing Address - Country:US
Mailing Address - Phone:671-649-2080
Mailing Address - Fax:671-649-2082
Practice Address - Street 1:590 S MARINE CORPS DRIVE
Practice Address - Street 2:SUITE 219 GITC BLDG
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-649-2080
Practice Address - Fax:671-649-2083
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUCP000022103TC0700X
HIPSY705103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical