=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558409441
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FERNANDO FRANCISCO DEGUZMAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2007
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3716 PACIFIC AVE SUITE D
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98418-7836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-474-7719
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1300 SW CAMPUS DR #5-7
-----------------------------------------------------
City | FEDERAL WAY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98023-5363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-988-3332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD00021562
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------