Healthcare Provider Details

I. General information

NPI: 1568428704
Provider Name (Legal Business Name): JAIME MAURICIO DEGUZMAN JR. LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 11/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 GRASS VALLEY HWY
AUBURN CA
95602-2002
US

IV. Provider business mailing address

10966 MORNING STAR LN
NEVADA CITY CA
95959-9796
US

V. Phone/Fax

Practice location:
  • Phone: 530-885-2909
  • Fax:
Mailing address:
  • Phone: 530-885-2909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 10241
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: