Provider Demographics
NPI:1780828186
Name:MAYRA LORENZO M.D PA
Entity Type:Organization
Organization Name:MAYRA LORENZO M.D PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSCIAN/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LORENZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-216-6188
Mailing Address - Street 1:12150 SEMINOLE BLVD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33778-2833
Mailing Address - Country:US
Mailing Address - Phone:727-216-6188
Mailing Address - Fax:727-216-6243
Practice Address - Street 1:12150 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-2833
Practice Address - Country:US
Practice Address - Phone:727-216-6188
Practice Address - Fax:727-216-6243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2014-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59120207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1447251061OtherNPI TYPE 1
FLE08564Medicare UPIN