Healthcare Provider Details

I. General information

NPI: 1700725140
Provider Name (Legal Business Name): CRYSTAL LOZADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6331 W ALTADENA AVE
GLENDALE AZ
85304-3110
US

IV. Provider business mailing address

6331 W ALTADENA AVE
GLENDALE AZ
85304-3110
US

V. Phone/Fax

Practice location:
  • Phone: 602-380-3383
  • Fax:
Mailing address:
  • Phone: 602-380-3383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: