Healthcare Provider Details

I. General information

NPI: 1013937614
Provider Name (Legal Business Name): VICENTE NEVARDO LOZADA MISION M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 CANDLEWOOD COMMONS
HOWELL NJ
07731
US

IV. Provider business mailing address

403 CANDLEWOOD COMMONS
HOWELL NJ
07731
US

V. Phone/Fax

Practice location:
  • Phone: 732-370-1900
  • Fax: 732-901-0916
Mailing address:
  • Phone: 732-370-1900
  • Fax: 732-901-0916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA038662
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: