Provider Demographics
NPI:1659170140
Name:PUNZALAN, GRAYSON TRAN
Entity type:Individual
Prefix:
First Name:GRAYSON
Middle Name:TRAN
Last Name:PUNZALAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2517 NESTLEBROOK TRL
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-8298
Mailing Address - Country:US
Mailing Address - Phone:757-338-8550
Mailing Address - Fax:
Practice Address - Street 1:2265 KRAFT DR
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6360
Practice Address - Country:US
Practice Address - Phone:540-231-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program