Provider Demographics
NPI:1972501435
Name:LOZANO, JESUS LORENZO (MD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:LORENZO
Last Name:LOZANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 MEDICAL CENTER DRIVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5002
Mailing Address - Country:US
Mailing Address - Phone:915-532-1466
Mailing Address - Fax:915-534-7914
Practice Address - Street 1:1600 MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE 410
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5002
Practice Address - Country:US
Practice Address - Phone:915-532-1466
Practice Address - Fax:915-534-7914
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0889208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME2824Medicaid
TX120338201Medicaid
TX120338205Medicaid
TX120338201Medicaid