MEDICARE: LORENA RENDON LASAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LASAC-13226	AZ

General Provider Information

NPI Number	:	1629811617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORENA RENDON LASAC

Provider Business Mailing Address
First Line	:	5037 W BLACKBIRD DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85742-5113
Country	:	US
Telephone Number	:	520-240-5083
Fax Number	:

Provider Business Practice Location Address
First Line	:	5037 W BLACKBIRD DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85742-5113
Country	:	US
Telephone Number	:	520-240-5083
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2024
Last Update Date	:	06/17/2024

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