Healthcare Provider Details

I. General information

NPI: 1194130880
Provider Name (Legal Business Name): JONATHAN LORENZANA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2014
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PALO ALTO RD STE 133
SAN ANTONIO TX
78211-3792
US

IV. Provider business mailing address

102 PALO ALTO RD STE 133
SAN ANTONIO TX
78211-3792
US

V. Phone/Fax

Practice location:
  • Phone: 210-923-9200
  • Fax:
Mailing address:
  • Phone: 210-923-9200
  • Fax: 210-923-9202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number2265
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: