Provider Demographics
NPI:1023346707
Name:ANGELA L. LORENZO, PA-C, LTD.
Entity type:Organization
Organization Name:ANGELA L. LORENZO, PA-C, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LORENZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-987-1555
Mailing Address - Street 1:PO BOX 36190
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-6190
Mailing Address - Country:US
Mailing Address - Phone:702-540-9220
Mailing Address - Fax:702-987-1455
Practice Address - Street 1:911 N BUFFALO DR UNIT 113
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0380
Practice Address - Country:US
Practice Address - Phone:702-987-1555
Practice Address - Fax:702-541-9180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA816261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care