Basic Information
| Provider Information | |||||||||
| NPI: | 1326431420 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOZANO | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | ANTHONY | ||||||||
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| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 658 E BRIER DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924082847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095010700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 658 E BRIER DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924082847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095010700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2015 | ||||||||
| LastUpdateDate: | 03/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 94749 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 106H00000X | 113764 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.