Provider Demographics
NPI:1619230216
Name:LOZANO, ROSA CANDIDA MEDINA
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:CANDIDA MEDINA
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 1:301 DELAFIELD PL NW
Mailing Address - Street 2:APT 207
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-4172
Mailing Address - Country:US
Mailing Address - Phone:703-309-7917
Mailing Address - Fax:
Practice Address - Street 1:301 DELAFIELD PL NW
Practice Address - Street 2:APT 207
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-4172
Practice Address - Country:US
Practice Address - Phone:703-309-7917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC2975387374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide