Provider Demographics
NPI:1366719650
Name:LOZANO, JOSE ANTONIO (MD, CSFA, OPA-C)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ANTONIO
Last Name:LOZANO
Suffix:
Gender:M
Credentials:MD, CSFA, OPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 LAUREL WOOD WAY
Mailing Address - Street 2:UNIT 104
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-3122
Mailing Address - Country:US
Mailing Address - Phone:786-863-0715
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY BLVD
Practice Address - Street 2:UNIVERSITY OF SAINT AUGUSTINE
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5799
Practice Address - Country:US
Practice Address - Phone:904-826-0084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant