Provider Demographics
NPI:1023392750
Name:SOLORZANO, BAYARDO E (LAC)
Entity Type:Individual
Prefix:
First Name:BAYARDO
Middle Name:E
Last Name:SOLORZANO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2353 RIO PINAR LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-7977
Mailing Address - Country:US
Mailing Address - Phone:407-484-9701
Mailing Address - Fax:
Practice Address - Street 1:1298 MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-7114
Practice Address - Country:US
Practice Address - Phone:407-484-9701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3001171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist