Provider Demographics
NPI:1720066947
Name:LOZANO, LUIS (PA)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:
Last Name:LOZANO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 5TH ST SE STE 110
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-2106
Mailing Address - Country:US
Mailing Address - Phone:253-845-9585
Mailing Address - Fax:253-848-1126
Practice Address - Street 1:3801 5TH ST SE STE 110
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-2106
Practice Address - Country:US
Practice Address - Phone:253-845-9585
Practice Address - Fax:253-848-1126
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA1003732363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA500518OtherWA LABOR & INDUSTRIES
WA2025150Medicaid
WA9394363OtherDSHS
WA5333LOOtherREGENCE
WAS64574Medicare UPIN