Provider Demographics
NPI:1124014766
Name:MUNOZ, LORENZO (MD)
Entity Type:Individual
Prefix:
First Name:LORENZO
Middle Name:
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4423 PARK BLVD N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-3540
Mailing Address - Country:US
Mailing Address - Phone:323-660-5624
Mailing Address - Fax:323-389-9128
Practice Address - Street 1:4423 PARK BLVD N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3540
Practice Address - Country:US
Practice Address - Phone:727-827-2825
Practice Address - Fax:727-827-2809
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2016-08-18
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-05-10
Provider Licenses
StateLicense IDTaxonomies
FLME118274207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016330500Medicaid
FLME118274OtherMEDICAL LICENSE
FL016330500Medicaid
CAA82735AMedicare PIN