Provider Demographics
NPI:1558441915
Name:LOSADA, MIGUEL ANGEL (MD)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:ANGEL
Last Name:LOSADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 EL CAJON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-1409
Mailing Address - Country:US
Mailing Address - Phone:619-282-2178
Mailing Address - Fax:619-282-2179
Practice Address - Street 1:3250 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-1409
Practice Address - Country:US
Practice Address - Phone:619-282-2178
Practice Address - Fax:619-282-2179
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA23249208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A232490Medicaid
A23444Medicare UPIN
A23249Medicare ID - Type Unspecified