# RAPHAEL F. GUANZON, M.D., PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871897058
- **Authorized official:** DR. RAPHAEL FAJARDO GUANZON M.D. (OWNER)
- **Authorized official phone:** (757) 399-0513

## Contact information

- **Practice address:** 704 LONDON ST, SUITE A, PORTSMOUTH, VA 23704-2413
- **Practice address phone:** (757) 399-0513
- **Practice address fax:** (757) 465-0785
- **Mailing address:** 704 LONDON ST, SUITE A, PORTSMOUTH, VA 23704-2413
- **Mailing address phone:** (757) 399-0513
- **Mailing address fax:** (757) 465-0785

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 0101026720 | VA | Yes |

## Other

- **Enumeration date:** 01/03/2011
- **Last updated:** 01/03/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 003121 | ANTHEM | VA |