Healthcare Provider Details

I. General information

NPI: 1598937781
Provider Name (Legal Business Name): LILY P LOVE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 LANG AVE NE STE 100
ALBUQUERQUE NM
87109-4597
US

IV. Provider business mailing address

5929 BALCONES DR STE 200
AUSTIN TX
78731-4280
US

V. Phone/Fax

Practice location:
  • Phone: 505-883-2574
  • Fax: 877-647-0202
Mailing address:
  • Phone: 512-550-1800
  • Fax: 877-647-0202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME101352
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number238246
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number026670
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD2009-0553
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: