Provider Demographics
NPI:1003022443
Name:ODON M LORENZO
Entity Type:Organization
Organization Name:ODON M LORENZO
Other - Org Name:ANGELS CARE MEDICAL TRANSPORTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ODON
Authorized Official - Middle Name:MIRANDA
Authorized Official - Last Name:LORENZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-350-3596
Mailing Address - Street 1:23517 FRIGATE AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-5726
Mailing Address - Country:US
Mailing Address - Phone:310-847-7888
Mailing Address - Fax:310-830-8463
Practice Address - Street 1:23517 FRIGATE AVE
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-5726
Practice Address - Country:US
Practice Address - Phone:310-847-7888
Practice Address - Fax:310-830-8463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9730536Medicaid