Provider Demographics
NPI:1275564163
Name:GONZALEZ, LORENZO (MD)
Entity Type:Individual
Prefix:DR
First Name:LORENZO
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
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 335
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-0335
Mailing Address - Country:US
Mailing Address - Phone:570-854-9925
Mailing Address - Fax:
Practice Address - Street 1:1357 AVE ASHFORD
Practice Address - Street 2:PMB #282
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1400
Practice Address - Country:US
Practice Address - Phone:570-854-9925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049946L2084P0800X, 2084P0804X
PR109842084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA745241KALMedicare ID - Type Unspecified
F41592Medicare UPIN
PR88658GOMedicare ID - Type Unspecified