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General NPI Number Information
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NPI Number | 1619775277
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Entity Type | Individual
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Provider Name | CARLOS DAVID LOZANO
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Gender | Male
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Dates
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Enumeration Date | 03/07/2025
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 1915 W MAIN ST
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-2725
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Country | US
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Telephone | 479-968-1198
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Fax | 479-967-1178
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Provider Business Mailing Address
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Address Line | 2911 LONGVIEW DR STE B
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City | JONESBORO
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State | AR
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Zip | 72401-5902
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Country | US
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Telephone | 870-336-0238
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Fax | 870-336-0239
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA4978
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License Number State | AR
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