Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | ME59007 | FL |
NPI | 1023014396 |
---|---|
Provider Name | Wilfredo Lorenzo |
First Address | St Petersburg, FL 33710-5473 |
Second Address | St Petersburg, FL 33710-5473 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E04115 | (02) |