Provider Demographics
NPI:1962874826
Name:LORENZANA, MIGUEL (SUDCC II)
Entity type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:
Last Name:LORENZANA
Suffix:
Gender:M
Credentials:SUDCC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1359 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-1016
Mailing Address - Country:US
Mailing Address - Phone:626-430-2900
Mailing Address - Fax:626-331-0035
Practice Address - Street 1:1359 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-1016
Practice Address - Country:US
Practice Address - Phone:626-430-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-30
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 172V00000X
CA3003373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist