Provider Demographics
NPI:1588393078
Name:DEGUZMAN, CHASTITY R (LMT)
Entity type:Individual
Prefix:
First Name:CHASTITY
Middle Name:R
Last Name:DEGUZMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 NUUANU AVE APT E1607
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-6029
Mailing Address - Country:US
Mailing Address - Phone:808-222-3595
Mailing Address - Fax:
Practice Address - Street 1:31 S BERETANIA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2220
Practice Address - Country:US
Practice Address - Phone:808-524-8588
Practice Address - Fax:720-836-6369
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI16088225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty