Healthcare Provider Details

I. General information

NPI: 1053055277
Provider Name (Legal Business Name): SANTIAGO DOMINGO LOZANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2337 ENDEAVOR
LAREDO TX
78041-1970
US

IV. Provider business mailing address

4800 ALBERTA AVE
EL PASO TX
79905-2709
US

V. Phone/Fax

Practice location:
  • Phone: 956-726-4929
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberW5866
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: