Basic Information
| Provider Information | |||||||||
| NPI: | 1275995409 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEGUZMAN | ||||||||
| FirstName: | ELIZA | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 410 PROVIDENCE LN NE | ||||||||
| Address2: | EMILIE GAMELIN PAVILION | ||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985066927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604935369 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 410 PROVIDENCE LN NE | ||||||||
| Address2: | EMILIE GAMELIN PAVILION | ||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985066927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604935369 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2016 | ||||||||
| LastUpdateDate: | 03/26/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P2201X | PH 00039667 | WA | Y |
No ID Information.