Healthcare Provider Details

I. General information

NPI: 1649729575
Provider Name (Legal Business Name): DR. JOHN LOVERN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E CHAPEL ST SUITE 1
SANTA MARIA CA
93454-4607
US

IV. Provider business mailing address

801 EAST CHAPEL SUITE 1
SANTA MARIA CA
93454-4607
US

V. Phone/Fax

Practice location:
  • Phone: 805-928-7361
  • Fax: 805-928-5742
Mailing address:
  • Phone: 805-928-7361
  • Fax: 805-928-5742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5064
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: