Provider Demographics
NPI:1386107464
Name:LOZANO, MARIEL (MD)
Entity type:Individual
Prefix:
First Name:MARIEL
Middle Name:
Last Name:LOZANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4318 MOONLIGHT WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5000
Mailing Address - Country:US
Mailing Address - Phone:210-558-8878
Mailing Address - Fax:210-558-9389
Practice Address - Street 1:4318 MOONLIGHT WAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5000
Practice Address - Country:US
Practice Address - Phone:210-558-8878
Practice Address - Fax:210-558-9389
Is Sole Proprietor?:No
Enumeration Date:2019-04-07
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT4206207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine