Provider Demographics
NPI:1700379427
Name:LOZACRUZ, MOISES (MSW)
Entity Type:Individual
Prefix:
First Name:MOISES
Middle Name:
Last Name:LOZACRUZ
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1942 HAMMOND AVE
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-9775
Mailing Address - Country:US
Mailing Address - Phone:626-848-8371
Mailing Address - Fax:
Practice Address - Street 1:6103 MOUNT TACOMA DR SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2727
Practice Address - Country:US
Practice Address - Phone:253-215-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW60844139OtherWA DEPT OF HEALTH