Provider Demographics
NPI:1962871822
Name:DEGUZMAN, MICHAEL JUAN
Entity type:Individual
Prefix:
First Name:MICHAEL JUAN
Middle Name:
Last Name:DEGUZMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8258 GOLDEN AVE
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945
Mailing Address - Country:US
Mailing Address - Phone:619-825-6814
Mailing Address - Fax:
Practice Address - Street 1:8258 GOLDEN AVE
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-2653
Practice Address - Country:US
Practice Address - Phone:619-825-6814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy