Provider Demographics
NPI:1386482537
Name:LOSWA, AGNES N
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:N
Last Name:LOSWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2043 SAN FRANCISCO AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-4146
Mailing Address - Country:US
Mailing Address - Phone:562-889-6599
Mailing Address - Fax:888-891-6599
Practice Address - Street 1:2761 SATURN ST STE J
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-6707
Practice Address - Country:US
Practice Address - Phone:562-889-4256
Practice Address - Fax:888-891-6599
Is Sole Proprietor?:No
Enumeration Date:2024-07-19
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24-368842106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician