Provider Demographics
NPI:1568472728
Name:DEGUZMAN, FELIX QUINTO (MD)
Entity type:Individual
Prefix:
First Name:FELIX
Middle Name:QUINTO
Last Name:DEGUZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2383 KHOURY LN
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-4972
Mailing Address - Country:US
Mailing Address - Phone:775-299-1064
Mailing Address - Fax:
Practice Address - Street 1:1993 ERRECART BLVD
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-8334
Practice Address - Country:US
Practice Address - Phone:775-753-1049
Practice Address - Fax:775-777-8494
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2018-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10392207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1568472728Medicaid
NVEA875XMedicare PIN
NV39138Medicare ID - Type Unspecified
NV1568472728Medicaid