Provider Demographics
NPI:1346326394
Name:DE LA LOZA, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:DE LA LOZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:922 S ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-4004
Mailing Address - Country:US
Mailing Address - Phone:323-500-1099
Mailing Address - Fax:323-825-4644
Practice Address - Street 1:942 S ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022
Practice Address - Country:US
Practice Address - Phone:323-263-9700
Practice Address - Fax:323-263-8042
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2018-08-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG082210207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG25796Medicare UPIN