Organization
DLORM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERTO B D'LORM GNP-BC (NURSE PRACTITIONER-GERONTOLOGY)
(512) 364-8494
Entity
Organization
Contact information
Practice address
4032 OUTPOST TRCE, LAGO VISTA, TX 78645-6456
(512) 364-8494
Mailing address
4032 OUTPOST TRCE, LAGO VISTA, TX 78645-6456
(512) 364-8494
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
672526
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
672526
LICENCE NUMBER
TX
Enumeration date
07/17/2012
Last updated
07/17/2012
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