Provider Demographics
NPI:1609560127
Name:LOZANO, GISELA ANAHI
Entity Type:Individual
Prefix:
First Name:GISELA
Middle Name:ANAHI
Last Name:LOZANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 BIG BND APT 101
Mailing Address - Street 2:
Mailing Address - City:ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-1273
Mailing Address - Country:US
Mailing Address - Phone:210-946-9241
Mailing Address - Fax:
Practice Address - Street 1:51111 WOODWARD AVE STE 150
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-5037
Practice Address - Country:US
Practice Address - Phone:248-254-2616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty