Provider Demographics
NPI:1750671103
Name:DE GUZMAN, TIMOTHY J (CRNA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:DE GUZMAN
Suffix:
Gender:M
Credentials:CRNA
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Other - Credentials:
Mailing Address - Street 1:330 BROOKLINE AVE
Mailing Address - Street 2:YAMINS 219
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5400
Mailing Address - Country:US
Mailing Address - Phone:617-667-3364
Mailing Address - Fax:617-667-5013
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:YAMINS 219
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-3364
Practice Address - Fax:617-667-5013
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2016-11-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2270440367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered