Provider Demographics
NPI:1306926423
Name:LLORENTE, EVELYNE N (MD)
Entity type:Individual
Prefix:DR
First Name:EVELYNE
Middle Name:N
Last Name:LLORENTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16152 BEACH BLVD STE 173
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3862
Mailing Address - Country:US
Mailing Address - Phone:714-885-8980
Mailing Address - Fax:888-988-5872
Practice Address - Street 1:16152 BEACH BLVD STE 173
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3862
Practice Address - Country:US
Practice Address - Phone:714-885-8980
Practice Address - Fax:888-988-5872
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63738207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG63738OtherMEDICAL LICENSE NUMBER
CAG63738OtherMEDICAL LICENSE NUMBER
CAG63738AMedicare ID - Type Unspecified
CAG63738OtherMEDICAL LICENSE NUMBER