Provider Demographics
NPI:1346483336
Name:LOZADA, WIMAR (MH)
Entity Type:Individual
Prefix:MR
First Name:WIMAR
Middle Name:
Last Name:LOZADA
Suffix:
Gender:F
Credentials:MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 BIG BUCK DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34772-8220
Mailing Address - Country:US
Mailing Address - Phone:407-749-3580
Mailing Address - Fax:
Practice Address - Street 1:1941 BIG BUCK DR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34772-8220
Practice Address - Country:US
Practice Address - Phone:407-749-3580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH22520101YM0800X
PR3116103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool