Basic Information
| Provider Information | |||||||||
| NPI: | 1629497482 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LORENZO | ||||||||
| FirstName: | DELFINO | ||||||||
| MiddleName: | ESTEVAN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6210 E US HWY 290 | ||||||||
| Address2: | STE. 420 - CREDENTIALING | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787231098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123383826 | ||||||||
| FaxNumber: | 5124066216 | ||||||||
| Practice Location | |||||||||
| Address1: | 3816 S 1ST ST | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124431311 | ||||||||
| FaxNumber: | 5124066266 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2014 | ||||||||
| LastUpdateDate: | 09/20/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | S0500 | TX | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 400938301 | 05 | TX | MEDICAID | 400938302 | 05 | TX | MEDICAID |