Provider Demographics
NPI:1982384822
Name:POLANIA LOZANO, TANIA JULIETH
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:JULIETH
Last Name:POLANIA LOZANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 SW 133RD AVENUE RD APT 323
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-5312
Mailing Address - Country:US
Mailing Address - Phone:786-833-2351
Mailing Address - Fax:
Practice Address - Street 1:8600 SW 133RD AVENUE RD APT 323
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-5312
Practice Address - Country:US
Practice Address - Phone:786-833-2351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-285548106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician