Provider Demographics
NPI:1639933179
Name:LOZA, GLENDA STEPHANIE (PA)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:STEPHANIE
Last Name:LOZA
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:PO BOX 1220
Mailing Address - Street 2:
Mailing Address - City:PORT ISABEL
Mailing Address - State:TX
Mailing Address - Zip Code:78578-1220
Mailing Address - Country:US
Mailing Address - Phone:956-299-1481
Mailing Address - Fax:
Practice Address - Street 1:2050 N EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-1734
Practice Address - Country:US
Practice Address - Phone:956-544-5557
Practice Address - Fax:956-544-5100
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA17635363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical