Provider Demographics
NPI:1144432824
Name:TITA DEGUZMAN INSURANCE AGENCY, INC
Entity type:Organization
Organization Name:TITA DEGUZMAN INSURANCE AGENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TITA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-348-0444
Mailing Address - Street 1:1241 GRAND AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4447
Mailing Address - Country:US
Mailing Address - Phone:909-348-0444
Mailing Address - Fax:909-348-0439
Practice Address - Street 1:20652 COLLEGEWOOD DR
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-1134
Practice Address - Country:US
Practice Address - Phone:909-444-9167
Practice Address - Fax:909-444-9167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities