Healthcare Provider Details

I. General information

NPI: 1326464447
Provider Name (Legal Business Name): SERGIO LOZANO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2014
Last Update Date: 04/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4115 PECAN BLVD STE B
MCALLEN TX
78501-3695
US

IV. Provider business mailing address

4115 PECAN BLVD STE B
MCALLEN TX
78501-3695
US

V. Phone/Fax

Practice location:
  • Phone: 956-686-6050
  • Fax: 956-686-6359
Mailing address:
  • Phone: 956-975-8850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA03917
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: