East Lake Medical, LLC

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

A48551 Issued in CA

Legal business name

EAST LAKE MEDICAL, LLC

Practice address

841 Kuhn Dr Ste 200
Chula Vista, CA 91914-4523

Phone

(619) 482-7301

Fax

(619) 482-6950

NPI assigned

Dec 6, 2012

Last updated

Dec 6, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Martha E Lozano, M.D.

Title

President

Phone

(619) 482-7301

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1354752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354752000000",
    "number": "1700121464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "841 KUHN DR STE 200",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919144523",
            "telephone_number": "619-482-7301",
            "fax_number": "619-482-6950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "841 KUHN DR STE 200",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919144523",
            "telephone_number": "619-482-7301",
            "fax_number": "619-482-6950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST LAKE MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-06",
        "last_updated": "2012-12-06",
        "status": "A",
        "authorized_official_last_name": "LOZANO",
        "authorized_official_first_name": "MARTHA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "619-482-7301",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "CA",
            "license": "A48551",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A485510",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pulmonary Disease Physician in Chula Vista, CA
• Providers in Chula Vista, CA by specialty
• Pulmonary Disease Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.