Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | CP000022 | GU |
Y | 103TC0700X | Clinical Psychologist | CP000022 | GU |
N | 103G00000X | Clinical Psychologist | PSY705 | HI |
N | 103TC0700X | Clinical Psychologist | PSY705 | HI |
NPI | 1003000761 |
---|---|
Provider Name | Ms. Patricia Leon Guerrero Taimanglo |
First Address | Tamuning, GU 96914 |
Second Address | Tamuning, GU 96913 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2007 |
Last Update Date | 05/09/2007 |