Provider Demographics
NPI:1851844435
Name:LOZANO LOPEZ, JAIRO EFRAIN (MS)
Entity Type:Individual
Prefix:
First Name:JAIRO
Middle Name:EFRAIN
Last Name:LOZANO LOPEZ
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 S ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1406
Mailing Address - Country:US
Mailing Address - Phone:559-497-5056
Mailing Address - Fax:
Practice Address - Street 1:1065 S ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1406
Practice Address - Country:US
Practice Address - Phone:559-497-5056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA130135106H00000X
CA89873106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist