Provider Demographics
NPI:1063000255
Name:ACUNA, LORENA (CARE GIVER)
Entity type:Individual
Prefix:
First Name:LORENA
Middle Name:
Last Name:ACUNA
Suffix:
Gender:F
Credentials:CARE GIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 E WOODSMAN PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-1096
Mailing Address - Country:US
Mailing Address - Phone:480-696-4158
Mailing Address - Fax:480-625-3156
Practice Address - Street 1:1890 E WOODSMAN PL
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-1096
Practice Address - Country:US
Practice Address - Phone:480-696-4158
Practice Address - Fax:480-625-3156
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ09205374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide