Healthcare Provider Details

I. General information

NPI: 1609732676
Provider Name (Legal Business Name): GABRIELA MICHELLE LOZANO CHACON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2026
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

858 W JACKMAN ST
LANCASTER CA
93534-2487
US

IV. Provider business mailing address

12619 E AVE V-14
PEARBLOSSOM CA
93553-2015
US

V. Phone/Fax

Practice location:
  • Phone: 661-522-1414
  • Fax:
Mailing address:
  • Phone: 661-522-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberY6406979
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: