Healthcare Provider Details

I. General information

NPI: 1790184307
Provider Name (Legal Business Name): DR. CHIQUITA LYNETTE A LOVING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHIQUITA LYNETTE A LOVING

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3011 N MAIN ST
LAS CRUCES NM
88001-1164
US

IV. Provider business mailing address

3011 NORTH MAIN STREET
LAS CRUCES NEW MEXICO
88001
UM

V. Phone/Fax

Practice location:
  • Phone: 575-647-8878
  • Fax: 575-647-8252
Mailing address:
  • Phone: 575-647-8878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007792
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: