Provider Demographics
NPI:1659421022
Name:LOZA, FERMIN
Entity Type:Individual
Prefix:MR
First Name:FERMIN
Middle Name:
Last Name:LOZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3378 SHASTA DR
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-3766
Mailing Address - Country:US
Mailing Address - Phone:415-725-1996
Mailing Address - Fax:
Practice Address - Street 1:890 HAYES ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-2615
Practice Address - Country:US
Practice Address - Phone:415-701-5174
Practice Address - Fax:415-621-1033
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040931101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)