Provider Demographics
NPI:1699900340
Name:DE GUZMAN, LEONIDEZ (MD)
Entity type:Individual
Prefix:DR
First Name:LEONIDEZ
Middle Name:
Last Name:DE GUZMAN
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 1:600 NW 11TH ST
Mailing Address - Street 2:STE E37
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-8604
Mailing Address - Country:US
Mailing Address - Phone:914-318-7428
Mailing Address - Fax:
Practice Address - Street 1:50 GUION PL APT 4K
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5516
Practice Address - Country:US
Practice Address - Phone:914-318-7428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD154002207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease