Basic Information
| Provider Information | |||||||||
| NPI: | 1831152958 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOZANO | ||||||||
| FirstName: | MARIA DE LA LUZ | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16600 W SPRAGUE RD | ||||||||
| Address2: | SUITE 80 | ||||||||
| City: | MIDDLEBURG HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441306318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408260500 | ||||||||
| FaxNumber: | 4408260501 | ||||||||
| Practice Location | |||||||||
| Address1: | 16600 W SPRAGUE RD | ||||||||
| Address2: | SUITE 80 | ||||||||
| City: | MIDDLEBURG HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441306318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408260500 | ||||||||
| FaxNumber: | 4408260501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2006 | ||||||||
| LastUpdateDate: | 07/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | 35.046596 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | 207P00000X | 35.046596 | OH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000359249 | 01 | OH | ANTHEM | OTHER | 0498117 | 05 | OH | MEDICAID | N371376 | 01 | OH | WELLCARE | OTHER | 3810016408 | 05 | WV | MEDICAID |