Healthcare Provider Details

I. General information

NPI: 1245952142
Provider Name (Legal Business Name): MISS YARITZA KORAIMA LOZANO BARRAGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 16TH ST STE B
MODESTO CA
95354-1119
US

IV. Provider business mailing address

920 16TH ST STE B
MODESTO CA
95354-1119
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-4595
  • Fax: 209-558-4595
Mailing address:
  • Phone: 209-552-2858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number126397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: