Healthcare Provider Details

I. General information

NPI: 1962040733
Provider Name (Legal Business Name): LUZ LOZANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2019
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2764 N LINCOLN AVE
CHICAGO IL
60614-6810
US

IV. Provider business mailing address

5063 W WINDSOR AVE
CHICAGO IL
60630-3926
US

V. Phone/Fax

Practice location:
  • Phone: 773-935-4325
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198001565
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227013723
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: