Healthcare Provider Details

I. General information

NPI: 1831152958
Provider Name (Legal Business Name): MARIA DE LA LUZ LOZANO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/21/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16600 W SPRAGUE RD SUITE 80
MIDDLEBURG HEIGHTS OH
44130-6318
US

IV. Provider business mailing address

16600 W SPRAGUE RD SUITE 80
MIDDLEBURG HEIGHTS OH
44130-6318
US

V. Phone/Fax

Practice location:
  • Phone: 440-826-0500
  • Fax: 440-826-0501
Mailing address:
  • Phone: 440-826-0500
  • Fax: 440-826-0501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number35.046596
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35.046596
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: