Provider Demographics
NPI:1417968512
Name:LOZANOV, NIKOLA YULIEV (MD)
Entity Type:Individual
Prefix:
First Name:NIKOLA
Middle Name:YULIEV
Last Name:LOZANOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93178207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI65858Medicare UPIN
CA00A931780Medicare PIN
CABA033YMedicare PIN