Provider Demographics
NPI:1881471019
Name:LORENZO, MIGUEL ALEJANDRO SR
Entity type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:ALEJANDRO
Last Name:LORENZO
Suffix:SR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MIGUEL
Other - Middle Name:ALEJANDRO
Other - Last Name:LORENZO
Other - Suffix:SR
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:426 E 62ND ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-1143
Mailing Address - Country:US
Mailing Address - Phone:786-890-7736
Mailing Address - Fax:
Practice Address - Street 1:426 E 62ND ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1143
Practice Address - Country:US
Practice Address - Phone:786-890-7742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-546246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant