Organization
LAS VEGAS MT76 INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LUIS LORENZANA (PRESIDENT)
(407) 994-6634
Entity
Organization
Contact information
Practice address
1101 MIRANDA LN, SUITE 131, KISSIMMEE, FL 34741-0769
(407) 994-6634
(407) 350-4109
Mailing address
1101 MIRANDA LN, SUITE 131, KISSIMMEE, FL 34741-0769
(407) 994-6634
(407) 350-4109
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
158002
FL
Other
Enumeration date
06/28/2016
Last updated
09/30/2016
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