Basic Information
| Provider Information | |||||||||
| NPI: | 1356530208 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOSEY | ||||||||
| FirstName: | TRAVIS | ||||||||
| MiddleName: | ERIK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | LOMA LINDA UNIVERSITY DEPT OF | ||||||||
| Address2: | 11175 CAMPUS STREET CP # 11108 | ||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923542741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095584907 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | LOMA LINDA UNIVERSITY DEPT OF | ||||||||
| Address2: | 11370 ANDERSON ST # 2400 | ||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923542741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095582880 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2007 | ||||||||
| LastUpdateDate: | 07/11/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | A84234 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | A84234 | 01 | CA | MEDICAL BOARD OF CALIFORNIA | OTHER |