Provider Demographics
NPI:1225621840
Name:GO, PROTACIO LORENZO
Entity Type:Individual
Prefix:
First Name:PROTACIO
Middle Name:LORENZO
Last Name:GO
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 1:21397 MIDWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-4400
Mailing Address - Country:US
Mailing Address - Phone:201-600-8271
Mailing Address - Fax:
Practice Address - Street 1:21397 MIDWAY BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-4400
Practice Address - Country:US
Practice Address - Phone:201-600-8271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program