Provider Demographics
NPI:1831930312
Name:BYROD, LORENA BEATRIZ (PPS CREDENTIAL IN CA)
Entity type:Individual
Prefix:
First Name:LORENA
Middle Name:BEATRIZ
Last Name:BYROD
Suffix:
Gender:F
Credentials:PPS CREDENTIAL IN CA
Other - Prefix:
Other - First Name:LORENA
Other - Middle Name:BEATRIZ
Other - Last Name:GALLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 DULVERTON CIR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6890
Mailing Address - Country:US
Mailing Address - Phone:661-547-7937
Mailing Address - Fax:
Practice Address - Street 1:200 DULVERTON CIR
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-6890
Practice Address - Country:US
Practice Address - Phone:661-547-7937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA200098437103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool