Provider Demographics
NPI:1114683679
Name:DE GUZMAN, RIZEL PATRICIO
Entity Type:Individual
Prefix:
First Name:RIZEL
Middle Name:PATRICIO
Last Name:DE GUZMAN
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 1:719 KAMEHAMEHA HWY STE C101
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-2773
Mailing Address - Country:US
Mailing Address - Phone:808-723-2921
Mailing Address - Fax:
Practice Address - Street 1:719 KAMEHAMEHA HWY STE C101
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-2773
Practice Address - Country:US
Practice Address - Phone:808-723-2921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI5104225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist