Healthcare Provider Details

I. General information

NPI: 1245714880
Provider Name (Legal Business Name): ALECK LOZANO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 E 11400 S # 121
SANDY UT
84070-6705
US

IV. Provider business mailing address

2759 W AMINI WAY
SOUTH JORDAN UT
84095-9269
US

V. Phone/Fax

Practice location:
  • Phone: 801-717-9230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12865616-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: