Healthcare Provider Details

I. General information

NPI: 1477833044
Provider Name (Legal Business Name): THE LOVELAND YOUTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 BOISE AVE
LOVELAND CO
80538-5037
US

IV. Provider business mailing address

2021 BOISE AVE
LOVELAND CO
80538-5037
US

V. Phone/Fax

Practice location:
  • Phone: 970-669-3298
  • Fax: 970-669-6244
Mailing address:
  • Phone: 970-669-3298
  • Fax: 970-669-6244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL QUINTANA
Title or Position: MEDICAL DOCTOR
Credential: M.D
Phone: 970-669-3298