Provider Demographics
NPI:1497999684
Name:DEGUZMAN, FRANCISCO S (IDMT-P)
Entity Type:Individual
Prefix:MR
First Name:FRANCISCO
Middle Name:S
Last Name:DEGUZMAN
Suffix:
Gender:M
Credentials:IDMT-P
Other - Prefix:
Other - First Name:FRANK
Other - Middle Name:
Other - Last Name:DEGUZMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:IDMT-P
Mailing Address - Street 1:208 W CASABLANCA AVE
Mailing Address - Street 2:27 SOMDG BLDG 1400 - OSM
Mailing Address - City:CANNON AFB
Mailing Address - State:NM
Mailing Address - Zip Code:88103-5009
Mailing Address - Country:US
Mailing Address - Phone:575-784-0287
Mailing Address - Fax:
Practice Address - Street 1:208 W CASABLANCA AVE BLDG 1400
Practice Address - Street 2:27 SOMDG - OSM
Practice Address - City:CANNON AFB
Practice Address - State:NM
Practice Address - Zip Code:88103-5009
Practice Address - Country:US
Practice Address - Phone:575-784-0287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-01
Last Update Date:2010-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians