Provider Demographics
NPI:1083348577
Name:LORICH, CHRISTOPHER LOUIS
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LOUIS
Last Name:LORICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 STRATHMORE CIR
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-8863
Mailing Address - Country:US
Mailing Address - Phone:727-457-0833
Mailing Address - Fax:
Practice Address - Street 1:1645 STRATHMORE CIR
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-8863
Practice Address - Country:US
Practice Address - Phone:727-457-0833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSI41125390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program