1790184307 NPI number — DR. CHIQUITA LYNETTE A LOVING

Table of content: DR. CHIQUITA LYNETTE A LOVING (NPI 1790184307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790184307 NPI number — DR. CHIQUITA LYNETTE A LOVING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOVING
Provider First Name:
CHIQUITA
Provider Middle Name:
LYNETTE A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOVING
Provider Other First Name:
CHIQUITA
Provider Other Middle Name:
LYNETTE A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1790184307
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3011 NORTH MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS CRUCES
Provider Business Mailing Address State Name:
NEW MEXICO
Provider Business Mailing Address Postal Code:
88001
Provider Business Mailing Address Country Code:
UM
Provider Business Mailing Address Telephone Number:
575-647-8878
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3011 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS CRUCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88001-1164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-647-8878
Provider Business Practice Location Address Fax Number:
575-647-8252
Provider Enumeration Date:
08/19/2014

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: 183500000X , with the licence number:  RP00007792 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: RP00007792 . This is a "PHARMACIST" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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