Provider Demographics
NPI:1568428704
Name:DEGUZMAN, JAIME MAURICIO JR (LAC)
Entity Type:Individual
Prefix:MR
First Name:JAIME
Middle Name:MAURICIO
Last Name:DEGUZMAN
Suffix:JR
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10966 MORNING STAR LN
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-9796
Mailing Address - Country:US
Mailing Address - Phone:530-885-2909
Mailing Address - Fax:
Practice Address - Street 1:3720 GRASS VALLEY HWY
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-2002
Practice Address - Country:US
Practice Address - Phone:530-885-2909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 10241171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist