Provider Demographics
NPI:1457794828
Name:LOZADA-SOLBERG, MARIBEL
Entity Type:Individual
Prefix:PROF
First Name:MARIBEL
Middle Name:
Last Name:LOZADA-SOLBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARIBEL
Other - Middle Name:
Other - Last Name:LOZADA-SOLBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1950 MILLER ST STE 5
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4760
Mailing Address - Country:US
Mailing Address - Phone:904-646-8711
Mailing Address - Fax:904-592-7770
Practice Address - Street 1:1950 MILLER ST STE 5
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073
Practice Address - Country:US
Practice Address - Phone:904-592-7834
Practice Address - Fax:904-592-7770
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH5603101YM0800X, 222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021179900Medicaid