Individual
JACKI MARIE DEGUZMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
10105 BANBURRY CROSS DR, SUITE 150, LAS VEGAS, NV 89144-6646
(702) 877-5199
(702) 854-3259
Mailing address
PO BOX 15645, SUITE 301, LAS VEGAS, NV 89114-5645
(702) 877-5199
(702) 854-3259
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
15384
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01612764
RAILROAD MEDICARE
—
01
—
V108806
SMA CONVENIENT CARE MEDICARE
NV
Enumeration date
04/04/2011
Last updated
01/17/2017
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