Healthcare Provider Details

I. General information

NPI: 1407975766
Provider Name (Legal Business Name): COFFEY LORENZO AND ASSOCIATEES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 FLYNN CIR
AUSTIN TX
78736-3053
US

IV. Provider business mailing address

7200 FLYNN CIR
AUSTIN TX
78736-3053
US

V. Phone/Fax

Practice location:
  • Phone: 512-771-8769
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberSA00060
License Number StateTX

VIII. Authorized Official

Name: DORSEY SHANTEL COFFEY
Title or Position: LICENSED SURGICAL ASSISTANT
Credential: L.S.A.
Phone: 512-771-8731