Provider Demographics
NPI:1053722496
Name:HERNANDEZ, LORENZO OMAR (MD)
Entity type:Individual
Prefix:DR
First Name:LORENZO
Middle Name:OMAR
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7751 9TH ST N STE 10
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-1102
Mailing Address - Country:US
Mailing Address - Phone:727-521-2424
Mailing Address - Fax:727-521-2425
Practice Address - Street 1:7751 9TH ST N STE 10
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-1102
Practice Address - Country:US
Practice Address - Phone:727-521-2424
Practice Address - Fax:727-521-2425
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME127800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018882800Medicaid