Provider Demographics
NPI:1366820821
Name:LOZANO, ELAINE MARIE (MS, RD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:MARIE
Last Name:LOZANO
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14605 POTOMAC BRANCH DR STE 210
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3337
Mailing Address - Country:US
Mailing Address - Phone:703-620-3211
Mailing Address - Fax:571-492-3059
Practice Address - Street 1:14605 POTOMAC BRANCH DR STE 210
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3337
Practice Address - Country:US
Practice Address - Phone:703-620-3211
Practice Address - Fax:571-492-3059
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered