Healthcare Provider Details

I. General information

NPI: 1386656510
Provider Name (Legal Business Name): MARIA G. LOZANO-DIAZ NMW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 NATIONAL AVE LOGAN HEIGHTS FAMILY HEALTH CENTER
SAN DIEGO CA
92113-2196
US

IV. Provider business mailing address

823 GATEWAY CENTER WAY
SAN DIEGO CA
92102-4541
US

V. Phone/Fax

Practice location:
  • Phone: 619-515-2300
  • Fax: 619-234-2447
Mailing address:
  • Phone: 619-515-2323
  • Fax: 619-906-4564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNMF700
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberNMW700
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: