MEDICARE: MARTHA RUTH LOZANO M.D.

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	208000000X	Pediatrics Physician	H1721	TX

General Provider Information

NPI Number	:	1205818374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA RUTH LOZANO M.D.

Provider Business Mailing Address
First Line	:	12739 WOODFOREST BLVD
Second Line	:	SUITE A
City	:	HOUSTON
State	:	TX
Zip	:	77015-2737
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12739 WOODFOREST BLVD
Second Line	:	SUITE A
City	:	HOUSTON
State	:	TX
Zip	:	77015-2737
Country	:	US
Telephone Number	:	713-450-2580
Fax Number	:	713-453-6196

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

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	07/16/2007

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