Provider Demographics
NPI:1396508966
Name:LOZA, LEONEL JR (LADC)
Entity type:Individual
Prefix:
First Name:LEONEL
Middle Name:
Last Name:LOZA
Suffix:JR
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 E 25TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-1227
Mailing Address - Country:US
Mailing Address - Phone:612-483-9803
Mailing Address - Fax:
Practice Address - Street 1:2600 E 25TH ST STE B
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-1227
Practice Address - Country:US
Practice Address - Phone:612-439-9803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306824101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)