Provider Demographics
NPI:1356574990
Name:LORENZO-HERNANDEZ, JOSE (PHD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:
Last Name:LORENZO-HERNANDEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 5 BOX 10682
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-9740
Mailing Address - Country:US
Mailing Address - Phone:178-796-7938
Mailing Address - Fax:
Practice Address - Street 1:CARR. 111
Practice Address - Street 2:KM 6.7
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-9740
Practice Address - Country:US
Practice Address - Phone:178-796-7938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1588103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist