Provider Demographics
NPI:1497386353
Name:LOSINIO, LEAN CARLO MENDOZA (CNM)
Entity Type:Individual
Prefix:
First Name:LEAN CARLO
Middle Name:MENDOZA
Last Name:LOSINIO
Suffix:
Gender:M
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 N LEMAI CT
Mailing Address - Street 2:
Mailing Address - City:DEDEDO
Mailing Address - State:GUAM
Mailing Address - Zip Code:96929
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:520 W SANTA MONICA AVE
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-5286
Practice Address - Country:US
Practice Address - Phone:671-635-4422
Practice Address - Fax:671-635-7493
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUNP0211363L00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner