Healthcare Provider Details

I. General information

NPI: 1285489971
Provider Name (Legal Business Name): ANGELICA CECILIA LOVATO
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: ATTICUS ANGEAL LOVATO

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8354 E NORTHFIELD BLVD UNIT 3700
DENVER CO
80238-3135
US

IV. Provider business mailing address

9152 W MEADOW DR
PEORIA AZ
85382-3107
US

V. Phone/Fax

Practice location:
  • Phone: 720-961-3764
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: