Healthcare Provider Details

I. General information

NPI: 1295553279
Provider Name (Legal Business Name): JUAN ANTONIO LOZANO CM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 NW 107TH AVE STE 110
MIAMI FL
33172-3100
US

IV. Provider business mailing address

270 E 34TH ST # 270A
HIALEAH FL
33013-2622
US

V. Phone/Fax

Practice location:
  • Phone: 305-964-5426
  • Fax:
Mailing address:
  • Phone: 305-772-0703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: