Provider Demographics
NPI:1194379735
Name:LOZANO, JESSICA (LVN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:LOZANO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 CARMEN LN STE 201
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7771
Mailing Address - Country:US
Mailing Address - Phone:805-212-7680
Mailing Address - Fax:
Practice Address - Street 1:212 CARMEN LN STE 201
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-7771
Practice Address - Country:US
Practice Address - Phone:805-212-7680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN187326164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1245897354OtherTELECARE CORPORATION