Provider Demographics
NPI:1366670747
Name:NIKOLA LOZANOV, M. D., INC.
Entity Type:Organization
Organization Name:NIKOLA LOZANOV, M. D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NIKOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOZANOV
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:707-782-1244
Mailing Address - Street 1:108 LYNCH CREEK WAY
Mailing Address - Street 2:SUITE #4
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-2357
Mailing Address - Country:US
Mailing Address - Phone:707-782-1244
Mailing Address - Fax:707-782-1163
Practice Address - Street 1:108 LYNCH CREEK WAY
Practice Address - Street 2:SUITE #4
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-2357
Practice Address - Country:US
Practice Address - Phone:707-782-1244
Practice Address - Fax:707-782-1163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93178207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA603AMedicare PIN