Provider Demographics
NPI:1174644835
Name:GUANZON MEDICAL OFFICE, INC
Entity Type:Organization
Organization Name:GUANZON MEDICAL OFFICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESITA
Authorized Official - Middle Name:V
Authorized Official - Last Name:GUANZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-272-3041
Mailing Address - Street 1:2395 MONTPELIER DR
Mailing Address - Street 2:#4
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1619
Mailing Address - Country:US
Mailing Address - Phone:408-272-3041
Mailing Address - Fax:408-272-3068
Practice Address - Street 1:2395 MONTPELIER DR
Practice Address - Street 2:#4
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1619
Practice Address - Country:US
Practice Address - Phone:408-272-3041
Practice Address - Fax:408-272-3068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA046670207R00000X
CAA046671207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ07659ZMedicare PIN
A046670Medicare PIN
CAE19014Medicare UPIN
CA00A466700Medicare ID - Type Unspecified