Provider Demographics
NPI:1104211705
Name:GUO, RONG RONG (MD)
Entity Type:Individual
Prefix:DR
First Name:RONG
Middle Name:RONG
Last Name:GUO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RONG
Other - Middle Name:
Other - Last Name:RONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:14065 N TERRITORY TRL
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-3351
Mailing Address - Country:US
Mailing Address - Phone:480-225-6542
Mailing Address - Fax:
Practice Address - Street 1:1441 N 12TH ST FL 2
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2837
Practice Address - Country:US
Practice Address - Phone:602-521-5200
Practice Address - Fax:602-521-5201
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16056207R00000X
IL036-132750207R00000X
AZ57149207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine