Provider Demographics
NPI:1497025928
Name:LLORENTE, GUILLERMO
Entity Type:Individual
Prefix:MR
First Name:GUILLERMO
Middle Name:
Last Name:LLORENTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12975 SW 132ND CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5820
Mailing Address - Country:US
Mailing Address - Phone:305-256-1653
Mailing Address - Fax:305-256-1663
Practice Address - Street 1:12975 SW 132ND CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5820
Practice Address - Country:US
Practice Address - Phone:305-256-1653
Practice Address - Fax:305-256-1663
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-5481238171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor