Healthcare Provider Details

I. General information

NPI: 1689671174
Provider Name (Legal Business Name): JOSEPH MARIO LOVATO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 06/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 RIO TRUMPEROS COURT NE
ALBUQUERQUE NM
87120-5333
US

IV. Provider business mailing address

4425 RIO TRUMPEROS CT NW
ALBUQUERQUE NM
87120-5333
US

V. Phone/Fax

Practice location:
  • Phone: 505-280-7370
  • Fax: 505-358-3787
Mailing address:
  • Phone: 505-280-7370
  • Fax: 505-358-3787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number98-320
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: