Healthcare Provider Details

I. General information

NPI: 1275518201
Provider Name (Legal Business Name): MARY JEAN S. DEGUZMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 SW 30TH AVE SUITE 101
POMPANO BEACH FL
33069-4887
US

IV. Provider business mailing address

12596 NW 67TH DR
PARKLAND FL
33076-1961
US

V. Phone/Fax

Practice location:
  • Phone: 954-633-3387
  • Fax: 954-633-3217
Mailing address:
  • Phone: 954-340-7041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberME70419
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME70419
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: