Provider Demographics
NPI:1649831223
Name:BUENAVENTURA, ALLAN CAGAMPAN (FNP)
Entity type:Individual
Prefix:MR
First Name:ALLAN
Middle Name:CAGAMPAN
Last Name:BUENAVENTURA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 E APACHE BLVD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-5817
Mailing Address - Country:US
Mailing Address - Phone:480-679-0799
Mailing Address - Fax:
Practice Address - Street 1:909 E APACHE BLVD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-5817
Practice Address - Country:US
Practice Address - Phone:480-967-0799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ231003363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily