Healthcare Provider Details

I. General information

NPI: 1962314393
Provider Name (Legal Business Name): EMILIANO DEGUZMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

954 BRUNELLO DR
SANTA ROSA CA
95407-6556
US

IV. Provider business mailing address

954 BRUNELLO DR
SANTA ROSA CA
95407-6556
US

V. Phone/Fax

Practice location:
  • Phone: 707-565-4101
  • Fax: 707-565-5183
Mailing address:
  • Phone: 707-565-4101
  • Fax: 707-565-5183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number287561
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: