Healthcare Provider Details

I. General information

NPI: 1700343183
Provider Name (Legal Business Name): PHILLIP LOVING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2019
Last Update Date: 02/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 UNIVERSITY PKWY # CE-120
SAN BERNARDINO CA
92407-2318
US

IV. Provider business mailing address

5500 UNIVERSITY PKWY # CE-120
SAN BERNARDINO CA
92407-2318
US

V. Phone/Fax

Practice location:
  • Phone: 909-537-3616
  • Fax: 909-922-7580
Mailing address:
  • Phone: 909-537-3616
  • Fax: 909-922-7580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2472E0500X
TaxonomyEEG Technician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: