Provider Demographics
NPI:1760952188
Name:LORENZO MEDINA, MEIKEL LAZARO
Entity Type:Individual
Prefix:
First Name:MEIKEL
Middle Name:LAZARO
Last Name:LORENZO MEDINA
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 1:6233 LAKEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-8812
Mailing Address - Country:US
Mailing Address - Phone:540-481-7382
Mailing Address - Fax:
Practice Address - Street 1:6233 LAKEVILLE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-8812
Practice Address - Country:US
Practice Address - Phone:540-481-7382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor