Provider Demographics
NPI:1275598211
Name:JOSEF GUANZON, PATROCINIO CRUZ (MD)
Entity Type:Individual
Prefix:MRS
First Name:PATROCINIO
Middle Name:CRUZ
Last Name:JOSEF GUANZON
Suffix:
Gender:F
Credentials:MD
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:114 SHEFFIELD DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541
Mailing Address - Country:US
Mailing Address - Phone:434-799-2810
Mailing Address - Fax:
Practice Address - Street 1:326 TAYLOR DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541
Practice Address - Country:US
Practice Address - Phone:434-799-5190
Practice Address - Fax:434-773-8184
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101022282208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
E47682Medicare UPIN