MEDICARE: DR. MAYRA L LORENZO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME59120	FL

General Provider Information

NPI Number	:	1447251061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAYRA L LORENZO M.D.

Provider Business Mailing Address
First Line	:	14690 SPRING HILL DR
Second Line	:	SUITE 100 ATTN:CREDENTIALING
City	:	SPRING HILL
State	:	FL
Zip	:	34609-8102
Country	:	US
Telephone Number	:	352-799-0046
Fax Number	:	352-606-2857

Provider Business Practice Location Address
First Line	:	12150 SEMINOLE BLVD
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33778
Country	:	US
Telephone Number	:	727-216-6188
Fax Number	:	727-216-6242

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2005
Last Update Date	:	06/09/2017

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