Provider Demographics
NPI:1871265611
Name:LOZANO, LISA MARGARET (PA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARGARET
Last Name:LOZANO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4402 BROADWAY BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-3400
Mailing Address - Country:US
Mailing Address - Phone:972-240-1789
Mailing Address - Fax:972-240-4615
Practice Address - Street 1:4402 BROADWAY BLVD STE 1
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-3400
Practice Address - Country:US
Practice Address - Phone:972-240-1789
Practice Address - Fax:972-240-4615
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02359363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical