Provider Demographics
NPI:1801375076
Name:LOZANO, ROBERT CARLOS
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CARLOS
Last Name:LOZANO
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 1:700 S 20TH ST
Mailing Address - Street 2:
Mailing Address - City:HIDALGO
Mailing Address - State:TX
Mailing Address - Zip Code:78557-3663
Mailing Address - Country:US
Mailing Address - Phone:956-451-2690
Mailing Address - Fax:
Practice Address - Street 1:300 S 2ND ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-2702
Practice Address - Country:US
Practice Address - Phone:956-683-7770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212860224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant