MEDICARE: MIKAELLA FAITH LOZA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1225842750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKAELLA FAITH LOZA

Provider Business Mailing Address
First Line	:	3011 ASTORIA BLVD APT 24
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11102-1723
Country	:	US
Telephone Number	:	646-321-1496
Fax Number	:

Provider Business Practice Location Address
First Line	:	3011 ASTORIA BLVD APT 24
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11102-1723
Country	:	US
Telephone Number	:	646-321-1496
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2025
Last Update Date	:	02/05/2025

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