Provider Demographics
NPI:1245082064
Name:LOZANO, JESUS
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:
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 1:3954 COPPER RIV
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-2568
Mailing Address - Country:US
Mailing Address - Phone:210-887-6069
Mailing Address - Fax:
Practice Address - Street 1:3954 COPPER RIV
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-2568
Practice Address - Country:US
Practice Address - Phone:210-887-6069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
TX1364860261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No171400000XOther Service ProvidersHealth & Wellness Coach