Healthcare Provider Details

I. General information

NPI: 1144432824
Provider Name (Legal Business Name): TITA DEGUZMAN INSURANCE AGENCY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20652 COLLEGEWOOD DR
WALNUT CA
91789-1134
US

IV. Provider business mailing address

1241 GRAND AVE SUITE H
DIAMOND BAR CA
91765-4447
US

V. Phone/Fax

Practice location:
  • Phone: 909-444-9167
  • Fax: 909-444-9167
Mailing address:
  • Phone: 909-348-0444
  • Fax: 909-348-0439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. TITA DE GUZMAN
Title or Position: CEO
Credential:
Phone: 909-348-0444