Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0102X | Surgical Critical Care | 35855 | AZ |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 35855 | AZ |
NPI | 1184638264 |
---|---|
Provider Name | Brian J Deguzman |
First Address | Paradise Valley, AZ 85253-6923 |
Second Address | Paradise Valley, AZ 85253-6923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 07/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
119216 | (05) | AZ |