Provider Demographics
NPI:1649976309
Name:LOZADA, IVAN EDGARDO
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:EDGARDO
Last Name:LOZADA
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 1:1651 JOE BATTLE BLVD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-0970
Mailing Address - Country:US
Mailing Address - Phone:915-849-9010
Mailing Address - Fax:
Practice Address - Street 1:1651 JOE BATTLE BLVD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-0970
Practice Address - Country:US
Practice Address - Phone:915-849-9010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2023-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1110013363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
F01230259OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION BOARD