Healthcare Provider Details

I. General information

NPI: 1851962716
Provider Name (Legal Business Name): ZACHARY DAVID LOVE DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 11/04/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 SHOREHAM PL STE 100
SAN DIEGO CA
92122-5904
US

IV. Provider business mailing address

PO BOX 601422
SAN DIEGO CA
92160-1422
US

V. Phone/Fax

Practice location:
  • Phone: 858-221-0344
  • Fax:
Mailing address:
  • Phone: 858-221-0344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95018014
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: