Provider Demographics
NPI:1679713820
Name:LOZIC, AJLA (MA)
Entity Type:Individual
Prefix:
First Name:AJLA
Middle Name:
Last Name:LOZIC
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10600 VILLAGE DR
Mailing Address - Street 2:UNIT 203D
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-4880
Mailing Address - Country:US
Mailing Address - Phone:727-460-0234
Mailing Address - Fax:
Practice Address - Street 1:10600 VILLAGE DR
Practice Address - Street 2:UNIT 203D
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-4880
Practice Address - Country:US
Practice Address - Phone:727-460-0234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-01
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005529300Medicaid