Provider Demographics
NPI:1558448555
Name:DE GUZMAN, ROWENA GRACE RAMIREZ (PT)
Entity Type:Individual
Prefix:MRS
First Name:ROWENA GRACE
Middle Name:RAMIREZ
Last Name:DE GUZMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7705 LUBAO AVE
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-2621
Mailing Address - Country:US
Mailing Address - Phone:818-998-5219
Mailing Address - Fax:
Practice Address - Street 1:7705 LUBAO AVE
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-2621
Practice Address - Country:US
Practice Address - Phone:818-998-5219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAP.T.32463225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ64281Medicare UPIN
CAWPT32463AMedicare ID - Type Unspecified