Provider Demographics
NPI:1891196531
Name:LAGORA, LOREX BOY (IDMT)
Entity Type:Individual
Prefix:
First Name:LOREX BOY
Middle Name:
Last Name:LAGORA
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 NW 91ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33150-2352
Mailing Address - Country:US
Mailing Address - Phone:786-553-3440
Mailing Address - Fax:
Practice Address - Street 1:1010 NW 91ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-2352
Practice Address - Country:US
Practice Address - Phone:786-553-3440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians