Healthcare Provider Details

I. General information

NPI: 1609785526
Provider Name (Legal Business Name): STEPHANIE LOZA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2236 E LINCOLN AVE
ANAHEIM CA
92806-4107
US

IV. Provider business mailing address

7252 SEBASTIAN AVE
RIVERSIDE CA
92509-5513
US

V. Phone/Fax

Practice location:
  • Phone: 712-461-3966
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS113027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: