Provider Demographics
NPI:1790290781
Name:DEGUZMAN, GIANNI (BEHAVIOR TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:GIANNI
Middle Name:
Last Name:DEGUZMAN
Suffix:
Gender:M
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 S 9TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-3747
Mailing Address - Country:US
Mailing Address - Phone:707-332-2100
Mailing Address - Fax:
Practice Address - Street 1:744 MONTGOMERY ST STE 400
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-2123
Practice Address - Country:US
Practice Address - Phone:415-989-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-17-38349106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician