Provider Demographics
NPI:1265666333
Name:LO PROFESSIONAL SERVICES, INC
Entity Type:Organization
Organization Name:LO PROFESSIONAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-646-1576
Mailing Address - Street 1:1036 RABUN LN
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780
Mailing Address - Country:US
Mailing Address - Phone:772-646-1576
Mailing Address - Fax:321-445-5407
Practice Address - Street 1:1036 RABUN LN
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780
Practice Address - Country:US
Practice Address - Phone:772-646-1576
Practice Address - Fax:321-445-5407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center