Healthcare Provider Details

I. General information

NPI: 1164342531
Provider Name (Legal Business Name): ANTONIO LOZADA ARZATE RT1518850326
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7550 JORDAN AVE APT 211
CANOGA PARK CA
91303-3310
US

IV. Provider business mailing address

7550 JORDAN AVE APT 211
CANOGA PARK CA
91303-3310
US

V. Phone/Fax

Practice location:
  • Phone: 747-777-1169
  • Fax:
Mailing address:
  • Phone: 747-777-1169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRT1518850326
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: