Healthcare Provider Details

I. General information

NPI: 1194437731
Provider Name (Legal Business Name): KRYSTAL ANN LOVINGS RCP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD
SACRAMENTO CA
95817-2201
US

IV. Provider business mailing address

817 N MILWAUKEE AVE APT 2
CHICAGO IL
60642-4193
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2011
  • Fax:
Mailing address:
  • Phone: 314-707-1190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number45364
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: