Healthcare Provider Details

I. General information

NPI: 1366687469
Provider Name (Legal Business Name): LESTER EUGENE LOVE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date: 11/20/2008
Reactivation Date: 12/04/2008

III. Provider practice location address

520 E TULARE AVE VISALIA ADULT INTEGRATED CLINIC
VISALIA CA
93292-3629
US

IV. Provider business mailing address

520 E TULARE AVE VISALIA ADULT INTEGRATED CLINIC
VISALIA CA
93292-3629
US

V. Phone/Fax

Practice location:
  • Phone: 559-623-0900
  • Fax: 559-733-0349
Mailing address:
  • Phone: 559-623-0900
  • Fax: 559-733-0349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA70095
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberA70095
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA70095
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberA70095
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: