Healthcare Provider Details

I. General information

NPI: 1972579522
Provider Name (Legal Business Name): WILLIAM ROBIN LOZANO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 OVERSEAS HWY STE 100
MARATHON FL
33050-2329
US

IV. Provider business mailing address

PO BOX 100707
ATLANTA GA
30384-2044
US

V. Phone/Fax

Practice location:
  • Phone: 305-434-1400
  • Fax:
Mailing address:
  • Phone: 305-434-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2506
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: