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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