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5801 Nw 151st St Miami Lakes FL 33014-2494 | |
| (305) 557-6755 | |
| (305) 557-1636 |
| Full Name | |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 5801 Nw 151st St, Miami Lakes, Florida |
| Authorized Official Name and Position | Angie Iribar (ADMINISTRATIVE ASSISTANT) |
| Authorized Official Contact | 3055576755 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
5801 Nw 151st St Ste 202 Miami Lakes FL 33014-2437 Ph: (305) 557-6755 | 5801 Nw 151st St Miami Lakes FL 33014-2494 Ph: (305) 557-6755 |
| NPI Number | 1508508052 |
|---|---|
| Provider Enumeration Date | 04/13/2022 |
| Last Update Date | 09/12/2022 |
| Certification Date | 09/12/2022 |
| Medicare PECOS PAC ID | 6800272089 |
|---|---|
| Medicare Enrollment ID | O20220927000745 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508508052 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | (* (Not Available)) | Primary |
| Provider Name | Omar Lorenzo |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1790853166 PECOS PAC ID: 1850311259 Enrollment ID: I20051130000538 |
| Provider Name | Dayana Rodriguez |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1134800121 PECOS PAC ID: 6305290818 Enrollment ID: I20231002001450 |
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