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General NPI Number Information
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NPI Number | 1114359692
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Entity Type | Individual
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Provider Name | SERGIO LORENZO ANDRE L.M.T
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Gender | Male
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Dates
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Enumeration Date | 08/06/2013
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Last Update Date | 08/06/2013
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Provider Practice Location Address
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Address Line | 19360 NW CORNELL RD
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City | HILLSBORO
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State | OR
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Zip | 97124-9378
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Country | US
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Telephone | 503-645-2950
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Fax |
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Provider Business Mailing Address
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Address Line | 19360 NW CORNELL RD
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City | HILLSBORO
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State | OR
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Zip | 97124-9378
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 18584
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License Number State | OR
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