Provider Demographics
NPI:1962270579
Name:LOZANO, KAITLYN RENAE
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:RENAE
Last Name:LOZANO
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 1:610 BUNTON RESERVE BLVD
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-2435
Mailing Address - Country:US
Mailing Address - Phone:512-903-0480
Mailing Address - Fax:
Practice Address - Street 1:637 CALLE VIOLETA
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-2716
Practice Address - Country:US
Practice Address - Phone:512-903-0480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty