Basic Information
| Provider Information | |||||||||
| NPI: | 1962874826 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LORENZANA | ||||||||
| FirstName: | MIGUEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CAODC-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1359 N GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917241016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264302900 | ||||||||
| FaxNumber: | 6263310035 | ||||||||
| Practice Location | |||||||||
| Address1: | 12531 HARBOR BLVD STE G | ||||||||
| Address2: | |||||||||
| City: | GARDEN GROVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928405824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146385008 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2015 | ||||||||
| LastUpdateDate: | 03/08/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 3003 | CA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 3003 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.