Healthcare Provider Details

I. General information

NPI: 1801489190
Provider Name (Legal Business Name): GERALDINE LOVATO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 CERRILLOS RD
SANTA FE NM
87505-3521
US

IV. Provider business mailing address

1501 CERRILLOS RD
SANTA FE NM
87505-3521
US

V. Phone/Fax

Practice location:
  • Phone: 505-985-2420
  • Fax: 505-212-0576
Mailing address:
  • Phone: 505-985-2420
  • Fax: 505-212-0576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCSA0208401
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: