Provider Demographics
NPI:1770529695
Name:DEGUZMAN, CORAZON (MD)
Entity type:Individual
Prefix:
First Name:CORAZON
Middle Name:
Last Name:DEGUZMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CORAZON
Other - Middle Name:
Other - Last Name:DEGUZMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:25900 N HIGHWAY 99
Mailing Address - Street 2:
Mailing Address - City:ACAMPO
Mailing Address - State:CA
Mailing Address - Zip Code:95220-9392
Mailing Address - Country:US
Mailing Address - Phone:209-339-9022
Mailing Address - Fax:209-339-9033
Practice Address - Street 1:39263 MISSION BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-3037
Practice Address - Country:US
Practice Address - Phone:510-796-4500
Practice Address - Fax:510-796-4573
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC38750174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C387501Medicare ID - Type UnspecifiedMEDICARE
CAD32465Medicare UPIN