Healthcare Provider Details

I. General information

NPI: 1124066303
Provider Name (Legal Business Name): ELEANOR DEGUZMAN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 11/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2767 E IMPERIAL HWY
BREA CA
92821-6713
US

IV. Provider business mailing address

PO BOX 105
YORBA LINDA CA
92885-0105
US

V. Phone/Fax

Practice location:
  • Phone: 714-578-8706
  • Fax:
Mailing address:
  • Phone: 714-572-3792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number29947
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number29947
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: