Provider Demographics
NPI:1639867443
Name:IRVING, JASON LORENZA
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:LORENZA
Last Name:IRVING
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 1:1605 N HOUSTON SCHOOL RD APT 8206
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75134-3083
Mailing Address - Country:US
Mailing Address - Phone:972-639-7147
Mailing Address - Fax:
Practice Address - Street 1:1605 N HOUSTON SCHOOL RD APT 8206
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75134-3083
Practice Address - Country:US
Practice Address - Phone:972-639-7147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46958240172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver