Healthcare Provider Details

I. General information

NPI: 1558292797
Provider Name (Legal Business Name): MARCOS LORES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2023 W 62ND ST
HIALEAH FL
33016-2678
US

IV. Provider business mailing address

2023 W 62ND ST
HIALEAH FL
33016-2678
US

V. Phone/Fax

Practice location:
  • Phone: 786-536-4399
  • Fax: 786-481-5891
Mailing address:
  • Phone: 786-536-4399
  • Fax: 786-481-5891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA20759
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: