Provider Demographics
NPI:1104250612
Name:GARAY-LOZANO, GEORGINA
Entity type:Individual
Prefix:
First Name:GEORGINA
Middle Name:
Last Name:GARAY-LOZANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GEORGINA
Other - Middle Name:
Other - Last Name:GARAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:24509 WALNUT ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2846
Mailing Address - Country:US
Mailing Address - Phone:661-414-2565
Mailing Address - Fax:
Practice Address - Street 1:24509 WALNUT ST STE 201
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-2846
Practice Address - Country:US
Practice Address - Phone:661-414-2565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91977106H00000X
CALMFT106706106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist