Provider Demographics
NPI:1053678847
Name:DAISY DEGANUZA MD LLC
Entity Type:Organization
Organization Name:DAISY DEGANUZA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDI
Authorized Official - Middle Name:
Authorized Official - Last Name:GERMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-715-9802
Mailing Address - Street 1:16554 N DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-1325
Mailing Address - Country:US
Mailing Address - Phone:813-968-7188
Mailing Address - Fax:813-968-7627
Practice Address - Street 1:16554 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-1325
Practice Address - Country:US
Practice Address - Phone:813-968-7188
Practice Address - Fax:813-968-7627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME31036103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30091Medicare PIN