Provider Demographics
NPI:1639351828
Name:IVETTE C. LOZANO DBA LOZANO MEDICAL CLINIC
Entity Type:Organization
Organization Name:IVETTE C. LOZANO DBA LOZANO MEDICAL CLINIC
Other - Org Name:LOZANO MEDICAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IVETTE
Authorized Official - Middle Name:CONCEPCION
Authorized Official - Last Name:LOZANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-660-1616
Mailing Address - Street 1:10425 GARLAND RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-2926
Mailing Address - Country:US
Mailing Address - Phone:214-660-1616
Mailing Address - Fax:214-660-1628
Practice Address - Street 1:10425 GARLAND RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-2926
Practice Address - Country:US
Practice Address - Phone:214-660-1616
Practice Address - Fax:214-660-1628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4310208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135757601Medicaid
TXF91036Medicare UPIN
TX135757601Medicaid