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General NPI Number Information
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NPI Number | 1295771905
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Entity Type | Organization
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Legal Business Name | LORENZO VICTORES MD INC
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 6450 W 21ST CT SUITE 205
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City | HIALEAH
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State | FL
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Zip | 33016-3946
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Country | US
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Telephone | 305-558-7160
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Fax | 305-558-7877
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Provider Business Mailing Address
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Address Line | 6450 W 21ST CT SUITE 205
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City | HIALEAH
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State | FL
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Zip | 33016-3946
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Country | US
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Telephone | 305-558-7160
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Fax | 305-558-7877
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Authorized Official
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Title or Position | OWNER
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Name | LORENZO VICTORES
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Credential | M.D.
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Telephone | 305-558-7160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME 51386
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License Number State | FL
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