Healthcare Provider Details

I. General information

NPI: 1881663979
Provider Name (Legal Business Name): GUY P. RANDAZZO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 03/30/2020
Certification Date: 03/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13522 NEWPORT AVE STE 102
TUSTIN CA
92780-3707
US

IV. Provider business mailing address

PO BOX 15090
ANAHEIM CA
92803-5090
US

V. Phone/Fax

Practice location:
  • Phone: 714-573-8200
  • Fax: 714-573-9401
Mailing address:
  • Phone: 714-577-2124
  • Fax: 714-577-2125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA22452
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: