Provider Demographics
NPI:1043565930
Name:DLORM LLC
Entity Type:Organization
Organization Name:DLORM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER-GERONTOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:B
Authorized Official - Last Name:D'LORM
Authorized Official - Suffix:
Authorized Official - Credentials:GNP-BC
Authorized Official - Phone:512-364-8494
Mailing Address - Street 1:4032 OUTPOST TRCE
Mailing Address - Street 2:
Mailing Address - City:LAGO VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:78645-6456
Mailing Address - Country:US
Mailing Address - Phone:512-364-8494
Mailing Address - Fax:
Practice Address - Street 1:4032 OUTPOST TRCE
Practice Address - Street 2:
Practice Address - City:LAGO VISTA
Practice Address - State:TX
Practice Address - Zip Code:78645-6456
Practice Address - Country:US
Practice Address - Phone:512-364-8494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX672526363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX672526OtherLICENCE NUMBER