Healthcare Provider Details

I. General information

NPI: 1972501435
Provider Name (Legal Business Name): JESUS LORENZO LOZANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 06/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MEDICAL CENTER DRIVE SUITE 410
EL PASO TX
79902-5002
US

IV. Provider business mailing address

1600 MEDICAL CENTER DRIVE SUITE 410
EL PASO TX
79902-5002
US

V. Phone/Fax

Practice location:
  • Phone: 915-532-1466
  • Fax: 915-534-7914
Mailing address:
  • Phone: 915-532-1466
  • Fax: 915-534-7914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJ0889
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: