Healthcare Provider Details

I. General information

NPI: 1134894579
Provider Name (Legal Business Name): SAN LORENZO PM & R LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 NW 170TH ST
NORTH MIAMI BEACH FL
33169-5521
US

IV. Provider business mailing address

4835 EUCALYPTUS DR
HOLLYWOOD FL
33021-7062
US

V. Phone/Fax

Practice location:
  • Phone: 305-651-1100
  • Fax:
Mailing address:
  • Phone: 330-519-8231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: MEILANI MAPA
Title or Position: OWNER
Credential:
Phone: 330-519-8231