Provider Demographics
NPI:1790967362
Name:CARLOS A LOZANO MD PA
Entity Type:Organization
Organization Name:CARLOS A LOZANO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOZANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:210-227-7119
Mailing Address - Street 1:525 RICHMOND
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-2008
Mailing Address - Country:US
Mailing Address - Phone:210-227-7119
Mailing Address - Fax:210-228-0264
Practice Address - Street 1:525 RICHMOND
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-2008
Practice Address - Country:US
Practice Address - Phone:210-227-7119
Practice Address - Fax:210-228-0264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8679207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034913601Medicaid
TX00MP86Medicare PIN
TXC18581Medicare UPIN