Basic Information
| Provider Information | |||||||||
| NPI: | 1861652331 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUANZON | ||||||||
| FirstName: | VERNA | ||||||||
| MiddleName: | LUZ | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CABIGAS | ||||||||
| OtherFirstName: | VERNA | ||||||||
| OtherMiddleName: | LUZ | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 118 OAKWOOD DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MADISON HEIGHTS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245723001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4348468421 | ||||||||
| FaxNumber: | 4348462655 | ||||||||
| Practice Location | |||||||||
| Address1: | 118 OAKWOOD DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MADISON HEIGHTS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245723001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4348468421 | ||||||||
| FaxNumber: | 4348462655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2008 | ||||||||
| LastUpdateDate: | 09/08/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0101243148 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1861652331 | 05 | VA | MEDICAID |