Provider Demographics
NPI:1144586389
Name:GONZALEZ, LORENZO L (CPO, LPO)
Entity type:Individual
Prefix:MR
First Name:LORENZO
Middle Name:L
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:CPO, LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11933 NETWORK BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3399
Mailing Address - Country:US
Mailing Address - Phone:210-616-0761
Mailing Address - Fax:210-616-0157
Practice Address - Street 1:11933 NETWORK BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-3399
Practice Address - Country:US
Practice Address - Phone:210-616-0761
Practice Address - Fax:210-616-0157
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist