Provider Information for 1104475565
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LUIS MANUEL LOZOYA LCSW
Sex: Male
NPI: 1104475565
Last Updated: 2022-11-08
Certification Date: 2022-10-14
Certification Date: 2022-10-14
Details
| Name | Value | ||||||||
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| NPI | 1104475565 | ||||||||
| Enumeration Date | 2019-09-09 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 650 HUEBNER RD FORT RILEY, KS 66442-4030 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 650 HUEBNER RD FORT RILEY, KS 66442-4030 United States Phone: 785-239-7208 | Fax:630-570-5779 | ||||||||
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