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General NPI Number Information
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NPI Number | 1710249040
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Entity Type | Individual
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Provider Name | JACKELINE LOZANO MSSE
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Gender | Female
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Dates
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Enumeration Date | 06/12/2012
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Last Update Date | 06/12/2012
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Provider Practice Location Address
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Address Line | 9777 QUEENS BLVD PENT HOUSE
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City | REGO PARK
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State | NY
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Zip | 11374-3335
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Country | US
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Telephone | 718-830-9274
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Fax |
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Provider Business Mailing Address
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Address Line | 8920 55TH AVE APT 6C
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City | ELMHURST
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State | NY
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Zip | 11373-4553
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Country | US
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Telephone | 917-544-9716
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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 | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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