Provider Demographics
NPI:1982039038
Name:LOZANO, MELISSA JOANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JOANNE
Last Name:LOZANO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:JOANNE
Other - Last Name:CASAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:19536 ELDERWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-6623
Mailing Address - Country:US
Mailing Address - Phone:831-206-1499
Mailing Address - Fax:
Practice Address - Street 1:9231 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4658
Practice Address - Country:US
Practice Address - Phone:310-275-5400
Practice Address - Fax:310-275-5410
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA23208363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant