Raphael Fajardo Guanzon, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

0101026720 Issued in VA

Practice address

704 London St # a
Portsmouth, VA 23704-2413

Phone

(757) 399-0513

NPI assigned

Aug 29, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Dr. Rafael Fajardo Guanzon Former name

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Raphael F. Guanzon, M.D., PLLC

  • General Practice Physician
  • Portsmouth, VA
  • NPI 1871897058
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1262217600000",
    "number": "1184732992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "704 LONDON ST # A",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237042413",
            "telephone_number": "757-399-0513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 LONDON ST # A",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237042413",
            "telephone_number": "757-399-0513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUANZON",
        "first_name": "RAPHAEL",
        "middle_name": "FAJARDO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2009-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "VA",
            "license": "0101026720",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005671213",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "003121",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RAFAEL",
            "last_name": "GUANZON",
            "middle_name": "FAJARDO",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Growingthru, Inc.
• Adam Groyer
• Leslie Weldon Grunden, FNP
• Elise Marie Grybos
• Anatoliy Olexandrovych Gryshchenko, IDHS
• Guardian Path Home Care LLC
• Guardians Integrity Care LLC
• Sarah Christine Gude
• Darcy Rae Guerricagoitia, AGACNP-BC
• Chapin Guiliante

• General Practice Physician in Portsmouth, VA
• Providers in Portsmouth, VA by specialty
• General Practice Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.