MEDICARE: AMARI LEILANI RENEE LOZANO ABA

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	106E00000X	Assistant Behavior Analyst

General Provider Information

NPI Number	:	1164306825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMARI LEILANI RENEE LOZANO ABA

Provider Business Mailing Address
First Line	:	5704 BALTIMORE DR UNIT 309
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91942-1661
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:	772-675-9100

Provider Business Practice Location Address
First Line	:	5704 BALTIMORE DR UNIT 309
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91942-1661
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:	772-675-9100

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

Provider Enumeration Date	:	08/04/2025
Last Update Date	:	08/04/2025

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