Provider Demographics
NPI:1720066947
Name:LOZANO, LUIS (PAC)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:LOZANO
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 3RD ST NE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4098
Mailing Address - Country:US
Mailing Address - Phone:253-833-7750
Mailing Address - Fax:253-887-9804
Practice Address - Street 1:122 3RD ST NE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4098
Practice Address - Country:US
Practice Address - Phone:253-833-7750
Practice Address - Fax:253-833-7469
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA1003732363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA182597OtherLABOR & INDUSTRIES
WAG8802256OtherMEDICARE LEGACY
WA9394363OtherDSHS
WA5333LOOtherREGENCE
WAS64574Medicare UPIN