Provider Demographics
NPI:1912049321
Name:CINTRON LORENZO, MARISARA (MD)
Entity type:Individual
Prefix:
First Name:MARISARA
Middle Name:
Last Name:CINTRON LORENZO
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 1:13030 BOTTESFORD DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6470
Mailing Address - Country:US
Mailing Address - Phone:787-397-3344
Mailing Address - Fax:
Practice Address - Street 1:8010 W COLONIAL DR UNIT 146-162
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-6101
Practice Address - Country:US
Practice Address - Phone:407-434-8080
Practice Address - Fax:407-434-8084
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN940208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022976300Medicaid
FL022976300Medicaid
FLJ9WZ9OtherFLORIDA BLUE