Provider Demographics
NPI:1134423320
Name:SANTOS GUTIERREZ, LORENZO MIGUEL (MD)
Entity type:Individual
Prefix:
First Name:LORENZO
Middle Name:MIGUEL
Last Name:SANTOS GUTIERREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12201 PLUM ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7803
Mailing Address - Country:US
Mailing Address - Phone:301-579-1000
Mailing Address - Fax:301-579-1005
Practice Address - Street 1:12201 PLUM ORCHARD DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904
Practice Address - Country:US
Practice Address - Phone:301-579-1000
Practice Address - Fax:301-579-1005
Is Sole Proprietor?:No
Enumeration Date:2011-01-02
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD0437412084P0800X
VA01012596262084P0800X
NY2692882084P0800X
MDD00807082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry