Healthcare Provider Details

I. General information

NPI: 1043872260
Provider Name (Legal Business Name): KRISTINA K. LOVELACE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 SEASCAPE DR
NEWPORT BEACH CA
92663-2730
US

IV. Provider business mailing address

7551 AMAZON DR UNIT C
HUNTINGTON BEACH CA
92647-8653
US

V. Phone/Fax

Practice location:
  • Phone: 714-376-4301
  • Fax:
Mailing address:
  • Phone: 714-376-4301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95013278
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number850502
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: