Provider Demographics
NPI:1750855805
Name:LEMOS, LORENA RENEE
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:RENEE
Last Name:LEMOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LORENA
Other - Middle Name:RENEE
Other - Last Name:GREEN, SULADIE, FUERTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 810
Mailing Address - Street 2:
Mailing Address - City:GOLD BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97444-0810
Mailing Address - Country:US
Mailing Address - Phone:541-813-2535
Mailing Address - Fax:541-813-2536
Practice Address - Street 1:615 5TH STREET
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9199
Practice Address - Country:US
Practice Address - Phone:541-813-2535
Practice Address - Fax:541-813-2536
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist