Healthcare Provider Details

I. General information

NPI: 1366719650
Provider Name (Legal Business Name): JOSE ANTONIO LOZANO MD, CSFA, OPA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY BLVD UNIVERSITY OF SAINT AUGUSTINE
ST AUGUSTINE FL
32086-5799
US

IV. Provider business mailing address

104 LAUREL WOOD WAY UNIT 104
ST AUGUSTINE FL
32086-3122
US

V. Phone/Fax

Practice location:
  • Phone: 904-826-0084
  • Fax:
Mailing address:
  • Phone: 786-863-0715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: