Healthcare Provider Details

I. General information

NPI: 1164661740
Provider Name (Legal Business Name): MARISOL LOZADA COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2009
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 S ORANGE AVE
ORLANDO FL
32806-6125
US

IV. Provider business mailing address

7540 SAND LAKE POINTE LOOP APT #302
ORLANDO FL
32809-7213
US

V. Phone/Fax

Practice location:
  • Phone: 407-852-3310
  • Fax:
Mailing address:
  • Phone: 407-854-9443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: