Provider Demographics
NPI:1619509197
Name:CLINICA SAN ANTONIO PLLC
Entity Type:Organization
Organization Name:CLINICA SAN ANTONIO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GILBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:LORENZANA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:980-613-8735
Mailing Address - Street 1:416 MCCULLOUGH DR STE 110
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4387
Mailing Address - Country:US
Mailing Address - Phone:980-613-8735
Mailing Address - Fax:980-613-8079
Practice Address - Street 1:416 MCCULLOUGH DR STE 110
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4387
Practice Address - Country:US
Practice Address - Phone:980-613-8735
Practice Address - Fax:980-613-8079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty