MEDICARE: LISA MARGARET 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	02359	TX

General Provider Information

NPI Number	:	1871265611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARGARET LOZANO PA

Provider Business Mailing Address
First Line	:	4402 BROADWAY BLVD STE 1
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75043-3400
Country	:	US
Telephone Number	:	972-240-1789
Fax Number	:	972-240-4615

Provider Business Practice Location Address
First Line	:	4402 BROADWAY BLVD STE 1
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75043-3400
Country	:	US
Telephone Number	:	972-240-1789
Fax Number	:	972-240-4615

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

Provider Enumeration Date	:	09/30/2021
Last Update Date	:	09/30/2021

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