Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 29947 | CA |
N | 2251P0200X | Physical Therapist - Pediatrics | 29947 | CA |
NPI | 1124066303 |
---|---|
Provider Name | Ms. Eleanor Deguzman |
First Address | Yorba Linda, CA 92885-0105 |
Second Address | Brea, CA 92821-6713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 19/11/2010 |