Provider Demographics
NPI:1922660869
Name:LORENZANA, GILBERTO ANTONIO
Entity Type:Individual
Prefix:
First Name:GILBERTO
Middle Name:ANTONIO
Last Name:LORENZANA
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 1:416 MCCULLOUGH DR
Mailing Address - Street 2:STE 110
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4387
Mailing Address - Country:US
Mailing Address - Phone:980-613-8735
Mailing Address - Fax:980-613-8079
Practice Address - Street 1:416 MCCULLOUGH DR
Practice Address - Street 2:STE 110
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4387
Practice Address - Country:US
Practice Address - Phone:980-613-8735
Practice Address - Fax:980-613-8079
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011939363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily