MEDICARE: MARIANA LOZANO

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	133V00000X	Registered Dietitian		NC

General Provider Information

NPI Number	:	1821988072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANA LOZANO

Provider Business Mailing Address
First Line	:	3504 GULF BLVD APT 9B
Second Line	:
City	:	SOUTH PADRE ISLAND
State	:	TX
Zip	:	78597-7075
Country	:	US
Telephone Number	:	737-231-4720
Fax Number	:

Provider Business Practice Location Address
First Line	:	3504 GULF BLVD APT 9B
Second Line	:
City	:	SOUTH PADRE ISLAND
State	:	TX
Zip	:	78597-7075
Country	:	US
Telephone Number	:	737-231-4720
Fax Number	:

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

Provider Enumeration Date	:	07/08/2025
Last Update Date	:	07/08/2025

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