Provider Demographics
NPI:1861501850
Name:LORENZO, CONSUELO TERESA (MD)
Entity Type:Individual
Prefix:
First Name:CONSUELO
Middle Name:TERESA
Last Name:LORENZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7710 MERCY ROAD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124
Mailing Address - Country:US
Mailing Address - Phone:402-398-5858
Mailing Address - Fax:402-398-5857
Practice Address - Street 1:7710 MERCY ROAD
Practice Address - Street 2:SUITE 307
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124
Practice Address - Country:US
Practice Address - Phone:402-398-5858
Practice Address - Fax:402-398-5857
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20268208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
095658OtherIA MEDICAID
NE47037661516Medicaid
G42707Medicare UPIN
NE47037661516Medicaid