Healthcare Provider Details

I. General information

NPI: 1366201980
Provider Name (Legal Business Name): JASMIN ALEXANDRA LOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 SISK RD STE 5A
MODESTO CA
95356-0540
US

IV. Provider business mailing address

PO BOX 3975
MODESTO CA
95352-3975
US

V. Phone/Fax

Practice location:
  • Phone: 209-202-3450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4520
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: