Provider Demographics
NPI:1467935700
Name:LORENZO GONZALEZ, MICHELLE LINARIS (MD)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LINARIS
Last Name:LORENZO GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:LORENZO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:HC 60 BOX 15262
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602
Mailing Address - Country:US
Mailing Address - Phone:939-286-7050
Mailing Address - Fax:
Practice Address - Street 1:CARR 411 KM 5.9
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-0060
Practice Address - Country:US
Practice Address - Phone:939-286-7050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR144061041C0700X
PR004115235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5079064OtherLICENSE