MEDICARE: FABIOLA 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

General Provider Information

NPI Number	:	1407195175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FABIOLA LOZANO RBT

Provider Business Mailing Address
First Line	:	PO BOX 668650
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33166-9420
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	419 W 49TH ST STE 210
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3657
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

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

Provider Enumeration Date	:	01/31/2013
Last Update Date	:	11/05/2018

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