Provider Demographics
NPI:1144630443
Name:DE GUZMAN, KASSANDRA JAIME (PT)
Entity type:Individual
Prefix:MRS
First Name:KASSANDRA
Middle Name:JAIME
Last Name:DE GUZMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:KASSANDRA
Other - Middle Name:OLIVEROS
Other - Last Name:JAIME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5282 74TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4109
Mailing Address - Country:US
Mailing Address - Phone:646-571-9690
Mailing Address - Fax:
Practice Address - Street 1:5282 74TH ST APT 3
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4109
Practice Address - Country:US
Practice Address - Phone:646-571-9690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY37170-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist