MEDICARE: NIKOLA LOZANOV MD INC

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	207Q00000X	Family Medicine Physician	A93178	CA

General Provider Information

NPI Number	:	1366670747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIKOLA LOZANOV MD INC

Provider Business Mailing Address
First Line	:	108 LYNCH CREEK WAY STE 4
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94954-2310
Country	:	US
Telephone Number	:	707-782-1244
Fax Number	:	707-782-1163

Provider Business Practice Location Address
First Line	:	108 LYNCH CREEK WAY STE 4
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94954-2310
Country	:	US
Telephone Number	:	707-782-1244
Fax Number	:	707-782-1163

Authorized Official
Title or Position	:	MD
Name	:	NIKOLA YULIEV LOZANOV
Credential	:	MD
Telephone Number	:	707-782-1244

Provider Enumeration Date	:	06/24/2009
Last Update Date	:	05/14/2026

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