Provider Demographics
NPI:1699865238
Name:LOZANO, CARLOS A (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:A
Last Name:LOZANO
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 1:525 RICHMOND
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-2008
Mailing Address - Country:US
Mailing Address - Phone:210-227-7119
Mailing Address - Fax:210-228-0264
Practice Address - Street 1:525 RICHMOND
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-2008
Practice Address - Country:US
Practice Address - Phone:210-227-7119
Practice Address - Fax:210-228-0264
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8679207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034913601Medicaid
TX034913601Medicaid
TXC18581Medicare UPIN