Provider Demographics
NPI:1548955834
Name:LORENZO, RAYDENIS
Entity type:Individual
Prefix:
First Name:RAYDENIS
Middle Name:
Last Name:LORENZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5353 W DESERT INN RD APT 1158
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-7945
Mailing Address - Country:US
Mailing Address - Phone:702-890-4767
Mailing Address - Fax:
Practice Address - Street 1:5353 W DESERT INN RD APT 1158
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-7945
Practice Address - Country:US
Practice Address - Phone:702-890-4767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier