Healthcare Provider Details

I. General information

NPI: 1710583943
Provider Name (Legal Business Name): GLORIA ANGELINA LOZANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 GATEWAY CENTER WAY
SAN DIEGO CA
92102-4541
US

IV. Provider business mailing address

1023 NEPTUNE DR
CHULA VISTA CA
91911-2422
US

V. Phone/Fax

Practice location:
  • Phone: 619-515-2300
  • Fax: 619-237-1856
Mailing address:
  • Phone: 619-255-7520
  • Fax: 619-713-0480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: