Provider Demographics
NPI:1922218064
Name:DEGUZMAN, REYNALDA M (MD)
Entity Type:Individual
Prefix:DR
First Name:REYNALDA
Middle Name:M
Last Name:DEGUZMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4361 BONIFACE PKWY
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4316
Mailing Address - Country:US
Mailing Address - Phone:907-333-1211
Mailing Address - Fax:907-333-1211
Practice Address - Street 1:4361 BONIFACE PKWY
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4316
Practice Address - Country:US
Practice Address - Phone:907-333-1211
Practice Address - Fax:907-333-8660
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA1732208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD1732Medicaid
AKMD1732Medicaid