Healthcare Provider Details

I. General information

NPI: 1750874418
Provider Name (Legal Business Name): ROSE HELENE LOVELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 MAIN ST STE A
BEN LOMOND CA
95005-9394
US

IV. Provider business mailing address

PO BOX 542
SANTA CRUZ CA
95061-0542
US

V. Phone/Fax

Practice location:
  • Phone: 831-427-3500
  • Fax:
Mailing address:
  • Phone: 831-427-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA173402
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: