Healthcare Provider Details

I. General information

NPI: 1598723249
Provider Name (Legal Business Name): KRISTIN W LORENZ DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4532 E CAMP LOWELL DR
TUCSON AZ
85712-1282
US

IV. Provider business mailing address

5055 E BROADWAY BLVD STE A-100
TUCSON AZ
85711-3640
US

V. Phone/Fax

Practice location:
  • Phone: 520-547-1887
  • Fax: 520-547-1893
Mailing address:
  • Phone: 520-327-0460
  • Fax: 520-795-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2769
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: