MEDICARE: MS. IVANA LOZANO RBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		TX

General Provider Information

NPI Number	:	1033790894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IVANA LOZANO RBT

Provider Business Mailing Address
First Line	:	13701 SUNSET HARBOR DR
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-1859
Country	:	US
Telephone Number	:	713-443-8689
Fax Number	:

Provider Business Practice Location Address
First Line	:	1799 KIRBY DR STE 110
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-5624
Country	:	US
Telephone Number	:	855-782-8222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2021
Last Update Date	:	04/14/2021

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