Provider Demographics
NPI:1366243347
Name:LOZANO, SAMMY
Entity type:Individual
Prefix:
First Name:SAMMY
Middle Name:
Last Name:LOZANO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 259TH ST
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-3216
Mailing Address - Country:US
Mailing Address - Phone:424-264-7489
Mailing Address - Fax:323-242-0600
Practice Address - Street 1:11900 AVALON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90061-2866
Practice Address - Country:US
Practice Address - Phone:323-242-0500
Practice Address - Fax:323-242-0600
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)