Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic |
NPI | 1962894667 |
---|---|
Provider Name | Fernando Guzman |
First Address | Falls Church, VA 22044-2102 |
Second Address | Falls Church, VA 22044-2102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2015 |
Last Update Date | 04/03/2015 |