Provider Demographics
NPI:1649230046
Name:LOZADA, LUIS A SR (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:A
Last Name:LOZADA
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 MUNOZ RIVERA
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-0064
Mailing Address - Country:US
Mailing Address - Phone:787-851-1923
Mailing Address - Fax:787-255-4260
Practice Address - Street 1:64 MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-0064
Practice Address - Country:US
Practice Address - Phone:787-851-1923
Practice Address - Fax:787-255-4260
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4522208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
063496OtherCRUZ AVIL
6230016OtherHUMANA
25462OtherSSS
8622OtherIMC
8622OtherIMC
063496OtherCRUZ AVIL