Provider Demographics
NPI:1326167172
Name:DELOLMO, LORENZO (LSA)
Entity Type:Individual
Prefix:
First Name:LORENZO
Middle Name:
Last Name:DELOLMO
Suffix:
Gender:M
Credentials:LSA
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 12567
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79913-0567
Mailing Address - Country:US
Mailing Address - Phone:915-240-8234
Mailing Address - Fax:915-875-0890
Practice Address - Street 1:421 STOTTS AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79932-2229
Practice Address - Country:US
Practice Address - Phone:915-875-0890
Practice Address - Fax:915-875-0890
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00002174400000X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No174400000XOther Service ProvidersSpecialist