Provider Demographics
NPI:1861002073
Name:PEREZ LORENZO, GIANCARLO (PA)
Entity Type:Individual
Prefix:
First Name:GIANCARLO
Middle Name:
Last Name:PEREZ LORENZO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JJ 21 CALLE 32
Mailing Address - Street 2:URB VILLA RITA
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-2804
Mailing Address - Country:US
Mailing Address - Phone:404-901-5084
Mailing Address - Fax:
Practice Address - Street 1:JJ 21 CALLE 32
Practice Address - Street 2:URB VILLA RITA
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-2804
Practice Address - Country:US
Practice Address - Phone:404-901-5084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR674363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical