Provider Demographics
NPI:1285241257
Name:LOZANO, FERNANDO (LCDC)
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:
Last Name:LOZANO
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4303 TEJAS PKWY
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77632-1358
Mailing Address - Country:US
Mailing Address - Phone:409-839-3857
Mailing Address - Fax:
Practice Address - Street 1:4303 TEJAS PKWY
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77632-1358
Practice Address - Country:US
Practice Address - Phone:409-839-3857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9859101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty