Provider Demographics
NPI:1487378477
Name:LOZANO, KENIA (CCAPP R1483970922)
Entity type:Individual
Prefix:
First Name:KENIA
Middle Name:
Last Name:LOZANO
Suffix:
Gender:F
Credentials:CCAPP R1483970922
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 GALINDO ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-2507
Mailing Address - Country:US
Mailing Address - Phone:510-935-2989
Mailing Address - Fax:
Practice Address - Street 1:3209 GALINDO ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-2507
Practice Address - Country:US
Practice Address - Phone:510-935-2989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1483970922101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)