Provider Demographics
NPI:1295713337
Name:LOZADA COSTAS, JOSE A (MD)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:A
Last Name:LOZADA COSTAS
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:PO BOX 190807
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-0807
Mailing Address - Country:US
Mailing Address - Phone:787-766-2083
Mailing Address - Fax:787-766-2089
Practice Address - Street 1:576 CALLE CESAR GONZALEZ STE 503
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3758
Practice Address - Country:US
Practice Address - Phone:787-766-2083
Practice Address - Fax:787-766-2089
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13841207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
84343Medicare ID - Type Unspecified
G88842Medicare UPIN