Provider Demographics
NPI:1235460122
Name:DE JESUS, LORENZITO OCA
Entity Type:Individual
Prefix:MR
First Name:LORENZITO
Middle Name:OCA
Last Name:DE JESUS
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 1:409 W 223RD ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-3640
Mailing Address - Country:US
Mailing Address - Phone:310-561-9393
Mailing Address - Fax:
Practice Address - Street 1:426 W CARSON ST STE 12
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-6983
Practice Address - Country:US
Practice Address - Phone:310-561-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-17
Last Update Date:2010-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)