Healthcare Provider Details

I. General information

NPI: 1356038582
Provider Name (Legal Business Name): THOMAS ANTHONY DEGUZMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 10/21/2023
Certification Date: 10/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 FLORIDA AVE STE 102
MODESTO CA
95350-4446
US

IV. Provider business mailing address

3604 N BENDER AVE
COVINA CA
91724-3401
US

V. Phone/Fax

Practice location:
  • Phone: 209-573-6147
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2965
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: