Healthcare Provider Details

I. General information

NPI: 1972589521
Provider Name (Legal Business Name): BEVERLY L LORENS RD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD MAIN HOSPITAL, ROOM G102
SACRAMENTO CA
95817-2201
US

IV. Provider business mailing address

4837 ALEXON WAY
SACRAMENTO CA
95841-4341
US

V. Phone/Fax

Practice location:
  • Phone: 916-703-3111
  • Fax: 916-703-3118
Mailing address:
  • Phone: 916-973-1773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberR406812
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: