MEDICARE: MR. LUIS LOZANO PA

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	363AM0700X	Medical Physician Assistant	PA1003732	WA
2	363AS0400X	Surgical Physician Assistant	PA1003732	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	500518	OTHER	WA	WA LABOR & INDUSTRIES
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720066947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LUIS LOZANO PA

Provider Business Mailing Address
First Line	:	3801 5TH ST SE STE 110
Second Line	:
City	:	PUYALLUP
State	:	WA
Zip	:	98374-2106
Country	:	US
Telephone Number	:	253-845-9585
Fax Number	:	253-848-1126

Provider Business Practice Location Address
First Line	:	3801 5TH ST SE STE 110
Second Line	:
City	:	PUYALLUP
State	:	WA
Zip	:	98374-2106
Country	:	US
Telephone Number	:	253-845-9585
Fax Number	:	253-848-1126

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

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	11/11/2024

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Directions to “ MR. LUIS LOZANO PA” Practice Location

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