Provider Demographics
NPI:1902835762
Name:VICTORES, LORENZO (MD)
Entity Type:Individual
Prefix:
First Name:LORENZO
Middle Name:
Last Name:VICTORES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6450 W 21ST CT
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-3946
Mailing Address - Country:US
Mailing Address - Phone:305-558-7160
Mailing Address - Fax:305-558-7877
Practice Address - Street 1:6450 W 21ST CT
Practice Address - Street 2:SUITE 205
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-3946
Practice Address - Country:US
Practice Address - Phone:305-558-7160
Practice Address - Fax:305-558-7877
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 51386207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL08422WMedicare PIN