Healthcare Provider Details

I. General information

NPI: 1689405599
Provider Name (Legal Business Name): BRIANDA LOZADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/12/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 JUDSON WAY
CHULA VISTA CA
91911-3540
US

IV. Provider business mailing address

1809 NATIONAL AVE
SAN DIEGO CA
92113-2113
US

V. Phone/Fax

Practice location:
  • Phone: 619-703-1999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: