=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700988136
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WLADIMIR PIZZUTO LORENTZ MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2006
-----------------------------------------------------
Last Update Date | 01/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15805 BISCAYNE BLVD STE 211
-----------------------------------------------------
City | AVENTURA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33160-5378
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-360-6315
-----------------------------------------------------
Fax | 786-360-6473
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15805 BISCAYNE BLVD STE 211
-----------------------------------------------------
City | AVENTURA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33160-5378
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-360-6315
-----------------------------------------------------
Fax | 786-360-6473
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | ME008932
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | ME80932
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------