Provider Demographics
NPI:1528392321
Name:PEREZ LOZADA, JUAN CARLOS L (MD)
Entity Type:Individual
Prefix:
First Name:JUAN CARLOS
Middle Name:L
Last Name:PEREZ LOZADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20 YORK ST SPC 2-213
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:203-785-7026
Mailing Address - Fax:203-737-1077
Practice Address - Street 1:20 YORK ST SPC 2-213
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-785-7026
Practice Address - Fax:203-737-1077
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-25
Last Update Date:2015-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0512712085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology