Provider Demographics
NPI:1609032044
Name:COLLINS, TABITA LOZANO (PA)
Entity Type:Individual
Prefix:
First Name:TABITA
Middle Name:LOZANO
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13121 SANDHURST PL
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-2136
Mailing Address - Country:US
Mailing Address - Phone:714-913-3845
Mailing Address - Fax:
Practice Address - Street 1:1274 N ROSE DR
Practice Address - Street 2:SUITE 122
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870
Practice Address - Country:US
Practice Address - Phone:714-961-0808
Practice Address - Fax:714-961-0115
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16147363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical