Provider Demographics
NPI:1235294430
Name:LORENZO S. BONGOLAN, M.D
Entity Type:Organization
Organization Name:LORENZO S. BONGOLAN, M.D
Other - Org Name:DBA COMPREHENSIVE ORTHOPAEDIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORENZO
Authorized Official - Middle Name:SALVADOR
Authorized Official - Last Name:BONGOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-873-8877
Mailing Address - Street 1:3424 W KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2906
Mailing Address - Country:US
Mailing Address - Phone:813-874-3170
Mailing Address - Fax:813-873-2220
Practice Address - Street 1:3424 W KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2906
Practice Address - Country:US
Practice Address - Phone:813-874-3170
Practice Address - Fax:813-873-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME27892174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty