Provider Demographics
NPI:1306551130
Name:LOZANO, DANIEL JF III (CMT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JF
Last Name:LOZANO
Suffix:III
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2164 AVENIDA ESPADA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-5629
Mailing Address - Country:US
Mailing Address - Phone:845-522-9909
Mailing Address - Fax:
Practice Address - Street 1:2164 AVENIDA ESPADA
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-5629
Practice Address - Country:US
Practice Address - Phone:845-522-9909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76947225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist