Provider Demographics
NPI:1063918191
Name:LORENZO, TANIA
Entity type:Individual
Prefix:
First Name:TANIA
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 1:1200 NW 78TH AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1817
Mailing Address - Country:US
Mailing Address - Phone:786-675-7799
Mailing Address - Fax:
Practice Address - Street 1:15196 SW 128TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6397
Practice Address - Country:US
Practice Address - Phone:786-675-7799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023066300Medicaid