Healthcare Provider Details

I. General information

NPI: 1881804599
Provider Name (Legal Business Name): EDGARDO LLORENS MD, OM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BARRIO SAN ANTON, LOTE 4,#858 SECTOR INDUSTRIAL PARQUE ESCORIAL
CAROLINA PR
00984
US

IV. Provider business mailing address

670 CALLE JULIO ANDINO
SAN JUAN PR
00924-2206
US

V. Phone/Fax

Practice location:
  • Phone: 787-757-6850
  • Fax:
Mailing address:
  • Phone: 787-644-4626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number9362
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: