Healthcare Provider Details

I. General information

NPI: 1316977713
Provider Name (Legal Business Name): AMANDA LOZANO OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5006 COPPER NE EXPLOR ABILITIES
ALBUQUERQUE NM
87108
US

IV. Provider business mailing address

6001 MOON ST NE APT 1322
ALBUQUERQUE NM
87111
US

V. Phone/Fax

Practice location:
  • Phone: 505-268-7988
  • Fax: 505-268-8021
Mailing address:
  • Phone: 505-797-5092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2273
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: