1366687469 NPI number — DR. LESTER EUGENE LOVE M.D.

Table of content: DR. LESTER EUGENE LOVE M.D. (NPI 1366687469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366687469 NPI number — DR. LESTER EUGENE LOVE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOVE
Provider First Name:
LESTER
Provider Middle Name:
EUGENE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366687469
Entity Type Code:
Individual
Replacement NPI:
1366687469
Last Update Date:
11/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
11/20/2008
NPI Reactivation Date:
12/04/2008

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 E TULARE AVE
Provider Second Line Business Mailing Address:
VISALIA ADULT INTEGRATED CLINIC
Provider Business Mailing Address City Name:
VISALIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93292-3629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-623-0900
Provider Business Mailing Address Fax Number:
559-733-0349

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 E TULARE AVE
Provider Second Line Business Practice Location Address:
VISALIA ADULT INTEGRATED CLINIC
Provider Business Practice Location Address City Name:
VISALIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93292-3629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-623-0900
Provider Business Practice Location Address Fax Number:
559-733-0349
Provider Enumeration Date:
12/14/2006

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: 2084A0401X , with the licence number:  A70095 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0802X , with the licence number: A70095 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: A70095 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: A70095 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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