Provider Demographics
NPI:1215098413
Name:LOZADA, GUIDO (MD)
Entity type:Individual
Prefix:
First Name:GUIDO
Middle Name:
Last Name:LOZADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GUIDO
Other - Middle Name:LOZADA
Other - Last Name:TSCHISCHKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4211 WAIALAE AVE
Mailing Address - Street 2:SUITE 203 TOWER
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5312
Mailing Address - Country:US
Mailing Address - Phone:808-735-0063
Mailing Address - Fax:
Practice Address - Street 1:4211 WAIALAE AVE
Practice Address - Street 2:SUITE 203 TOWER
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5312
Practice Address - Country:US
Practice Address - Phone:808-735-0063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4116208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
051N1050412OtherAMA
BYDBBJPOtherAMA
73705730012OtherMEDICAL EDUCATION
C98834Medicare UPIN