Provider Demographics
NPI:1497873442
Name:LOZANO MENDOZA, MANUEL ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:ANTONIO
Last Name:LOZANO MENDOZA
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:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-0430
Mailing Address - Country:US
Mailing Address - Phone:787-745-9145
Mailing Address - Fax:787-745-9145
Practice Address - Street 1:URB VILLA BLANCA
Practice Address - Street 2:CALLE AMATISTA EDIFICIO 101
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-745-9145
Practice Address - Fax:787-745-9145
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2010-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR83171100000X
PR6002208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR61101OtherHUMANA GOLD CHOICE
PR0027262OtherTRIPLE S
PR500029SEOtherMMM HEALTHCARE
PR61101OtherHUMANA GOLD CHOICE
PR0027262OtherTRIPLE S