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General NPI Number Information
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NPI Number | 1669595757
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Entity Type | Organization
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Legal Business Name | LOZANO INTERNAL MEDICINE LLC
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 04/16/2010
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Provider Practice Location Address
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Address Line | 320 STATE ROAD 60 E STE 301
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City | LAKE WALES
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State | FL
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Zip | 33853-3750
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Country | US
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Telephone | 863-678-1400
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 919317
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City | ORLANDO
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State | FL
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Zip | 32891-9317
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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 | OWNER - PROVIDER
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Name | GILBERTO LOZANO
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Credential | MD
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Telephone | 863-678-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME84676
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License Number State | FL
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