Healthcare Provider Details

I. General information

NPI: 1568628220
Provider Name (Legal Business Name): GRACE DEGUZMAN ZAGUIRRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2008
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1495 FOREST HILL BLVD SUITE A
WEST PALM BEACH FL
33406-6073
US

IV. Provider business mailing address

1495 FOREST HILL BLVD SUITE A
WEST PALM BEACH FL
33406-6073
US

V. Phone/Fax

Practice location:
  • Phone: 561-968-5553
  • Fax: 561-300-2115
Mailing address:
  • Phone: 561-968-5553
  • Fax: 561-300-2115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9231814
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: