Individual
DR. RAPHAEL FAJARDO GUANZON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
704 LONDON ST # A, PORTSMOUTH, VA 23704-2413
(757) 399-0513
Mailing address
704 LONDON ST # A, PORTSMOUTH, VA 23704-2413
(757) 399-0513
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
05
—
005671213
—
VA
Enumeration date
08/29/2006
Last updated
12/31/2009
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