Provider Demographics
NPI:1073649000
Name:LOZANO, AIDA YVONNE (MS)
Entity Type:Individual
Prefix:
First Name:AIDA
Middle Name:YVONNE
Last Name:LOZANO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:YVONNE
Other - Middle Name:
Other - Last Name:LOZANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:4969 MONTAIR AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2742
Mailing Address - Country:US
Mailing Address - Phone:310-898-5379
Mailing Address - Fax:
Practice Address - Street 1:1085 W. VICTORIA STREET
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220
Practice Address - Country:US
Practice Address - Phone:310-868-5379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48844106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist