Provider Demographics
NPI:1659478212
Name:DE GUZMAN, RONALDO CRUZ (DO)
Entity Type:Individual
Prefix:DR
First Name:RONALDO
Middle Name:CRUZ
Last Name:DE GUZMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 VIKING LN
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-3333
Mailing Address - Country:US
Mailing Address - Phone:856-616-2892
Mailing Address - Fax:
Practice Address - Street 1:330 E GREENTREE RD
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-9467
Practice Address - Country:US
Practice Address - Phone:856-596-9050
Practice Address - Fax:856-596-0320
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB065660207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0460982000OtherAMERIHEALTH
NJ7440405Medicaid
919018OtherAETNA
G58337Medicare UPIN
NJ7440405Medicaid
080163485Medicare PIN