Healthcare Provider Details

I. General information

NPI: 1275564163
Provider Name (Legal Business Name): LORENZO GONZALEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1357 AVE ASHFORD PMB #282
SAN JUAN PR
00907-1400
US

IV. Provider business mailing address

PO BOX 335
GROVE CITY PA
16127-0335
US

V. Phone/Fax

Practice location:
  • Phone: 570-854-9925
  • Fax:
Mailing address:
  • Phone: 570-854-9925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD049946L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number10984
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number10984
License Number StatePR
# 4
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD049946L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: