Individual
DEANA M LOZADA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3860 W OGDEN AVE, CHICAGO, IL 60623-2460
(872) 588-3000
Mailing address
3860 W OGDEN AVE, CHICAGO, IL 60623-2460
(872) 588-3000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085008051
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085008051
STATE LICENSE
IL
01
—
1158232
SPECIALTY BOARDS
IL
01
—
385006172
CS LICENSE
IL
Enumeration date
04/21/2020
Last updated
04/09/2024
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