1952446106 NPI number — MRS. CARLA LOZANO VIZZERRA DPT

Table of content: MRS. CARLA LOZANO VIZZERRA DPT (NPI 1952446106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952446106 NPI number — MRS. CARLA LOZANO VIZZERRA DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VIZZERRA
Provider First Name:
CARLA
Provider Middle Name:
LOZANO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOZANO
Provider Other First Name:
CARLA
Provider Other Middle Name:
MABELLE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952446106
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
642 S ALASKA ST
Provider Second Line Business Mailing Address:
#209
Provider Business Mailing Address City Name:
PALMER
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99645-6342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-746-0722
Provider Business Mailing Address Fax Number:
907-746-0732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
642 S ALASKA ST
Provider Second Line Business Practice Location Address:
#209
Provider Business Practice Location Address City Name:
PALMER
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99645-6342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-746-0722
Provider Business Practice Location Address Fax Number:
907-746-0732
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1584 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PT7391 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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