MEDICARE: JONATHAN MICHAEL DEGUZMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	E5335	CA

General Provider Information

NPI Number	:	1962820597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN MICHAEL DEGUZMAN

Provider Business Mailing Address
First Line	:	3031 W MARCH LN STE 310
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95219-6562
Country	:	US
Telephone Number	:	209-472-0800
Fax Number	:

Provider Business Practice Location Address
First Line	:	3031 W MARCH LN STE 310
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95219-6562
Country	:	US
Telephone Number	:	209-472-0800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2014
Last Update Date	:	07/21/2022

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