Provider Demographics
NPI:1417048893
Name:GUANZON, RYAN ROMMEL SORIANO (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN ROMMEL
Middle Name:SORIANO
Last Name:GUANZON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1400 E. KINCAID STREET
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4127
Mailing Address - Country:US
Mailing Address - Phone:360-428-2500
Mailing Address - Fax:360-428-6485
Practice Address - Street 1:110 N LAVENTURE RD STE C
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-3901
Practice Address - Country:US
Practice Address - Phone:360-814-8240
Practice Address - Fax:360-848-4502
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD60091837207R00000X
TN41518207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN41518OtherMEDICAL LICENSE
WA263680OtherLABOR & INDUSTRIES
WA263680OtherLABOR & INDUSTRIES