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General NPI Number Information
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NPI Number | 1366670747
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Entity Type | Organization
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Legal Business Name | NIKOLA LOZANOV, M. D., INC.
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Dates
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Enumeration Date | 06/24/2009
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Last Update Date | 08/21/2009
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Provider Practice Location Address
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Address Line | 108 LYNCH CREEK WAY SUITE #4
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City | PETALUMA
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State | CA
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Zip | 94954-2357
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Country | US
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Telephone | 707-782-1244
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Fax | 707-782-1163
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Provider Business Mailing Address
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Address Line | 108 LYNCH CREEK WAY SUITE #4
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City | PETALUMA
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State | CA
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Zip | 94954-2357
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Country | US
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Telephone | 707-782-1244
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Fax | 707-782-1163
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Authorized Official
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Title or Position | PRESIDENT
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Name | NIKOLA LOZANOV
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Credential | M. D.
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Telephone | 707-782-1244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A93178
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License Number State | CA
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