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General NPI Number Information
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NPI Number | 1578186466
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Entity Type | Individual
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Provider Name | JOSHUA LOZANO
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Gender | Male
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Dates
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Enumeration Date | 05/26/2020
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Last Update Date | 05/26/2020
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Provider Practice Location Address
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Address Line | 1612 S BIG BEND BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63117-2208
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Country | US
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Telephone | 314-529-1391
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Fax |
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Provider Business Mailing Address
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Address Line | 827 E WAYMIRE AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63119-1746
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Country | US
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Telephone | 575-635-5766
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 2018040809
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License Number State | MO
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