Provider Demographics
NPI:1871515221
Name:LOZANO, RAUL A (PA-C)
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:A
Last Name:LOZANO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9495 MARSH LN STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-4946
Mailing Address - Country:US
Mailing Address - Phone:214-351-0010
Mailing Address - Fax:214-351-0375
Practice Address - Street 1:9495 MARSH LN STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-4946
Practice Address - Country:US
Practice Address - Phone:214-351-0010
Practice Address - Fax:214-351-0375
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02356363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS79564Medicare UPIN