Healthcare Provider Details

I. General information

NPI: 1770529695
Provider Name (Legal Business Name): CORAZON DEGUZMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: CORAZON DEGUZMAN M.D.

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39263 MISSION BLVD
FREMONT CA
94539-3037
US

IV. Provider business mailing address

25900 N HIGHWAY 99
ACAMPO CA
95220-9392
US

V. Phone/Fax

Practice location:
  • Phone: 510-796-4500
  • Fax: 510-796-4573
Mailing address:
  • Phone: 209-339-9022
  • Fax: 209-339-9033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC38750
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: