MEDICARE: DR. VERNA LUZ GUANZON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101243148	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861652331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VERNA LUZ GUANZON M.D.

Provider Business Mailing Address
First Line	:	118 OAKWOOD DR
Second Line	:	SUITE A
City	:	MADISON HEIGHTS
State	:	VA
Zip	:	24572-3001
Country	:	US
Telephone Number	:	434-846-8421
Fax Number	:	434-846-2655

Provider Business Practice Location Address
First Line	:	118 OAKWOOD DR
Second Line	:	SUITE A
City	:	MADISON HEIGHTS
State	:	VA
Zip	:	24572-3001
Country	:	US
Telephone Number	:	434-846-8421
Fax Number	:	434-846-2655

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	09/08/2016

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