Healthcare Provider Details

I. General information

NPI: 1912273434
Provider Name (Legal Business Name): JACQUELINE R LOZANO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 RETREAT AVE STE 900
HARTFORD CT
06106-2553
US

IV. Provider business mailing address

100 RETREAT AVE STE 900
HARTFORD CT
06106-2553
US

V. Phone/Fax

Practice location:
  • Phone: 860-218-2245
  • Fax: 860-218-2245
Mailing address:
  • Phone: 860-218-2245
  • Fax: 860-218-2245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number283952
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number63947
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: