Healthcare Provider Details

I. General information

NPI: 1144584541
Provider Name (Legal Business Name): ROSE ELLEN LOZANO MARRIAGE AND FAMILY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date: 10/31/2012
Reactivation Date: 02/28/2020

III. Provider practice location address

2222 FOOTHILL BLVD # 225
LA CANADA CA
91011-1456
US

IV. Provider business mailing address

2222 FOOTHILL BLVD # 225
LA CANADA CA
91011-1456
US

V. Phone/Fax

Practice location:
  • Phone: 818-696-3300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number142013
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number142013
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: