Provider Demographics
NPI:1609415744
Name:TAWAGON, GUEN CECILIA
Entity Type:Individual
Prefix:
First Name:GUEN CECILIA
Middle Name:
Last Name:TAWAGON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9401 W BONITOS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-4428
Mailing Address - Country:US
Mailing Address - Phone:623-313-8711
Mailing Address - Fax:
Practice Address - Street 1:8410 W THOMAS RD STE 112
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3356
Practice Address - Country:US
Practice Address - Phone:623-873-1500
Practice Address - Fax:623-873-4247
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN136234363LF0000X
AZ235953363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily