Provider Demographics
NPI:1104041995
Name:LOZANO, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LOZANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 E HOLT BLVD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-1618
Mailing Address - Country:US
Mailing Address - Phone:909-467-1605
Mailing Address - Fax:909-467-1608
Practice Address - Street 1:402 E HOLT BLVD
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-1618
Practice Address - Country:US
Practice Address - Phone:909-467-1605
Practice Address - Fax:909-467-1608
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54737208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A547370Medicaid
CAZZZ26321ZMedicare ID - Type Unspecified
CAH69568Medicare UPIN