Provider Demographics
NPI:1447070974
Name:LOZADA, ISRAEL JR (LMT, LMI)
Entity type:Individual
Prefix:
First Name:ISRAEL
Middle Name:
Last Name:LOZADA
Suffix:JR
Gender:M
Credentials:LMT, LMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400-2 E CENTRAL TEXAS EXPY STE B
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-7300
Mailing Address - Country:US
Mailing Address - Phone:254-245-7796
Mailing Address - Fax:
Practice Address - Street 1:4400-2 E CENTRAL TEXAS EXPY STE B
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-7300
Practice Address - Country:US
Practice Address - Phone:254-245-7796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT131095225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist