Healthcare Provider Details

I. General information

NPI: 1689081366
Provider Name (Legal Business Name): SARAH ELIZABETH LOVATO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5904 HOLLY AVE NE
ALBUQUERQUE NM
87113-2472
US

IV. Provider business mailing address

5904 HOLLY AVE NE
ALBUQUERQUE NM
87113-2472
US

V. Phone/Fax

Practice location:
  • Phone: 505-298-2505
  • Fax: 505-298-2985
Mailing address:
  • Phone: 52-982-5055
  • Fax: 505-298-2985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2014-0034
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: