Provider Demographics
NPI:1558347153
Name:DEGUZMAN, JOHN V (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:V
Last Name:DEGUZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 N 32ND ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3953
Mailing Address - Country:US
Mailing Address - Phone:602-258-4018
Mailing Address - Fax:
Practice Address - Street 1:4400 N 32ND ST
Practice Address - Street 2:SUITE 140
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3953
Practice Address - Country:US
Practice Address - Phone:602-258-4018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22208174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ22208OtherSTATE LICENSE
AZ22208OtherSTATE LICENSE
AZF75593Medicare UPIN
AZZ63234Medicare ID - Type UnspecifiedMEDICARE