Healthcare Provider Details

I. General information

NPI: 1285857565
Provider Name (Legal Business Name): MR. GILBERT LOZANO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 BAIRD AVE 101
RESEDA CA
91335-4150
US

IV. Provider business mailing address

7101 BAIRD AVE 101
RESEDA CA
91335-4150
US

V. Phone/Fax

Practice location:
  • Phone: 818-342-5897
  • Fax: 818-345-6256
Mailing address:
  • Phone: 818-342-5897
  • Fax: 818-345-6256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRI-L1006072051
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: