Provider Demographics
NPI:1932371507
Name:LORENZO MUNOZ
Entity Type:Organization
Organization Name:LORENZO MUNOZ
Other - Org Name:POWAY MEDICAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRINDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-335-4012
Mailing Address - Street 1:13525 MIDLAND RD
Mailing Address - Street 2:STE F
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-4772
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13525 MIDLAND RD
Practice Address - Street 2:STE F
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-4772
Practice Address - Country:US
Practice Address - Phone:858-335-4012
Practice Address - Fax:858-486-9101
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LORENZO MUNOZ
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-24
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty