Provider Demographics
NPI:1700287034
Name:SAN LORENZO ADULT PROVIDER SERVICES AND PEDIATRICS LLC
Entity Type:Organization
Organization Name:SAN LORENZO ADULT PROVIDER SERVICES AND PEDIATRICS LLC
Other - Org Name:SAN LORENZO ADULT PROVIDER SERVICES AND PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-799-3199
Mailing Address - Street 1:5819 SUN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-3517
Mailing Address - Country:US
Mailing Address - Phone:915-799-3199
Mailing Address - Fax:915-799-3199
Practice Address - Street 1:5819 SUN VALLEY DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-3517
Practice Address - Country:US
Practice Address - Phone:915-799-3199
Practice Address - Fax:915-799-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-05
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX016371253Z00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive Care