Provider Demographics
NPI:1407850175
Name:BOSQUE HERNANDEZ, LORENZO E (MD)
Entity Type:Individual
Prefix:
First Name:LORENZO
Middle Name:E
Last Name:BOSQUE HERNANDEZ
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 1:145 CALLE GUARAGUAO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7101
Mailing Address - Country:US
Mailing Address - Phone:787-760-6604
Mailing Address - Fax:787-292-0130
Practice Address - Street 1:145 CALLE GUARAGUAO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-7101
Practice Address - Country:US
Practice Address - Phone:787-760-6604
Practice Address - Fax:787-292-0130
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10796208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR83047Medicare ID - Type Unspecified
PRF64265Medicare UPIN