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Organization
RAPHAEL F. GUANZON, M.D., PLLC
Active
Organization
RAPHAEL F. GUANZON, M.D., PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAPHAEL FAJARDO GUANZON M.D. (OWNER)
(757) 399-0513
Entity
Organization
Contact information
Practice address
704 LONDON ST, SUITE A, PORTSMOUTH, VA 23704-2413
(757) 399-0513
(757) 465-0785
Mailing address
704 LONDON ST, SUITE A, PORTSMOUTH, VA 23704-2413
(757) 399-0513
(757) 465-0785
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
0101026720
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003121
ANTHEM
VA
Enumeration date
01/03/2011
Last updated
01/03/2011
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