Provider Demographics
NPI:1386180370
Name:DEGUZMAN, TANICE ELLEN
Entity Type:Individual
Prefix:MISS
First Name:TANICE
Middle Name:ELLEN
Last Name:DEGUZMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TANICE
Other - Middle Name:ELLEN
Other - Last Name:DEGUZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29207 BAY BRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92585-5615
Mailing Address - Country:US
Mailing Address - Phone:858-829-1371
Mailing Address - Fax:
Practice Address - Street 1:29207 BAY BRIDGE COURT
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92585
Practice Address - Country:US
Practice Address - Phone:858-829-1371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician