Provider Demographics
NPI:1194081554
Name:MAYORGA, ANDREA LORENA
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LORENA
Last Name:MAYORGA
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 1:1485 S SEMORAN BLVD
Mailing Address - Street 2:SUITE 1402
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32792-6141
Mailing Address - Country:US
Mailing Address - Phone:321-397-3006
Mailing Address - Fax:
Practice Address - Street 1:1485 S SEMORAN BLVD
Practice Address - Street 2:SUITE 1402
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32792-6141
Practice Address - Country:US
Practice Address - Phone:321-397-3006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator