Provider Demographics
NPI:1134302193
Name:LLOREN, ELLAINE (DO)
Entity Type:Individual
Prefix:
First Name:ELLAINE
Middle Name:
Last Name:LLOREN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 841969
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1969
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18350 TIMBER FOREST DR
Practice Address - Street 2:SUITE 100
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-2957
Practice Address - Country:US
Practice Address - Phone:281-446-2196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics