Provider Demographics
NPI:1811460140
Name:LOZANO, MARIO ANTONIO (ATC)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:ANTONIO
Last Name:LOZANO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1247 GANNET LN
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:CA
Mailing Address - Zip Code:95363-9071
Mailing Address - Country:US
Mailing Address - Phone:209-531-5095
Mailing Address - Fax:
Practice Address - Street 1:1247 GANNET LN
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:CA
Practice Address - Zip Code:95363-9071
Practice Address - Country:US
Practice Address - Phone:209-531-5095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABOC2976622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer