Provider Demographics
NPI:1417100256
Name:DEGUZMAN, JASMINE RONQUILLO (MA, IMFT #69934)
Entity Type:Individual
Prefix:MRS
First Name:JASMINE
Middle Name:RONQUILLO
Last Name:DEGUZMAN
Suffix:
Gender:F
Credentials:MA, IMFT #69934
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 W BADILLO ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1837
Mailing Address - Country:US
Mailing Address - Phone:626-893-0647
Mailing Address - Fax:
Practice Address - Street 1:416 W BADILLO ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1837
Practice Address - Country:US
Practice Address - Phone:626-893-0647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMFT 69934106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist