Provider Demographics
NPI:1750368163
Name:ROSSARO, LORENZO (MD)
Entity type:Individual
Prefix:DR
First Name:LORENZO
Middle Name:
Last Name:ROSSARO
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 1:4150 V STREET
Mailing Address - Street 2:STE 3500
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817
Mailing Address - Country:US
Mailing Address - Phone:916-734-3751
Mailing Address - Fax:916-734-7908
Practice Address - Street 1:4150 V ST
Practice Address - Street 2:STE 3500
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1460
Practice Address - Country:US
Practice Address - Phone:916-734-3751
Practice Address - Fax:916-734-7908
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68436207RI0008X, 207RT0003X, 207RG0100X
CA00A684360174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
No174400000XOther Service ProvidersSpecialist
No207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A684360Medicaid
CA00A684360Medicaid
CA00A684360Medicare ID - Type Unspecified