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General NPI Number Information
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NPI Number | 1477042414
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Entity Type | Individual
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Provider Name | SAMANTHA LOZANO
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Gender | Female
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Dates
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Enumeration Date | 05/04/2018
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Last Update Date | 10/02/2018
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Provider Practice Location Address
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Address Line | 1650 SPRUCE ST STE 250
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City | RIVERSIDE
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State | CA
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Zip | 92507-7429
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Country | US
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Telephone | 760-815-9056
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Fax |
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Provider Business Mailing Address
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Address Line | 9505 ARLINGTON AVE APT 6
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City | RIVERSIDE
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State | CA
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Zip | 92503-1214
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-18-31997
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License Number State | CA
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