Provider Demographics
NPI:1477608446
Name:VASQUEZ, LORENZO (LSA)
Entity Type:Individual
Prefix:MR
First Name:LORENZO
Middle Name:
Last Name:VASQUEZ
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 860031
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75086-0031
Mailing Address - Country:US
Mailing Address - Phone:817-294-7444
Mailing Address - Fax:214-838-3637
Practice Address - Street 1:7451 CHAPEL AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-7090
Practice Address - Country:US
Practice Address - Phone:817-294-7444
Practice Address - Fax:817-294-7172
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00417363AS0400X
TX246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical